Lab CPT code - 87260, 87280, 87471,87497, 87501 - Infectious Disease Molecular Diagnostic Testing


Molecular diagnostic testing, which includes DNA- or RNA-based analysis, with or without amplification/quantification, provides sensitive, specific and timely (i.e., relative to that of traditional culture-based methods) identification of diverse biological entities, including microorganisms and tumors. The current LCD will focus upon such techniques for the former category, in which three basic nucleic acid assay platforms are utilized.
A standardized nucleic acid probe reacts directly with nucleic acids in the test sample. This format is termed a Nucleic Acid Test (NAT). If the test sample contains the organism of interest, then the reaction (e.g., hybridization) of these elements will create a detectable endpoint.
In the second case, test sample nucleic acid is detected following amplification. This format is termed a Nucleic Acid Amplification Test (NAAT). The NAAT format increases diagnostic sensitivity by decreasing the lower limit of detection. Several techniques are available to perform such amplification, but one example is the polymerase chain reaction in which logarithmic copies of baseline nucleic acid material can be replicated via cyclical reactions involving "primer" nucleic acid, enzymes and requisite heating/cooling parameters.
Finally, there may be a need for the above process to quantify, rather than simply detect the presence of, certain microorganisms. Examples include Human Immunodeficiency Virus (HIV), hepatitis C and Cytomegalovirus (CMV) treatment, which can require such quantitative monitoring to determine if therapy is producing the intended reductions in circulating levels of virus.
Furthermore, other techniques (i.e., nucleic acid sequencing) are utilized to assay anti-viral resistance signatures for HIV-1 and hepatitis C. Either genotypic or phenotypic analysis can allow therapy to be directed in response to such observed resistance markers.
There are many different organisms whose clinical presentations can be grouped into several categories or clusters. The table below denotes infectious disease manifestations for those organisms where specific CPT codes exist versus organisms which would require non-specific coding. Other organisms, in addition to those listed below, may also require molecular diagnostic testing.
Cluster
Organisms With CPT Codes
Organisms Without Codes
Clinical Features
Systemic
Bartonella henselae; Bartonella quintana; Borrelia burgdorferi;Enterovirus; Herpes virus-6
Ehrlichia species; Leishmania species; Parvovirus B19; Babesia species;Herpes virus-7; West Nile virus
Endocarditis, fever, peliosis hepatis, hepatitis, rash, cat-scratch disease, oculo-glandular fever, bacillary angiomatosis, encephalitis, lymphadenopathy, meningismus, anorexia, headache, shock, myalgia, arthralgia, Bell’s palsy, meningitis, fatigue, heart block, tick exposure, erythema chronicum migrans, leukopenia, leukocytosis, low platelets
Respiratory
Chlamydia pneumoniae; Mycoplasma pneumoniae; Legionella pneumophila
Bordetella pertussis; respiratory syncytial virus; Adenovirus; Parainfluenza virus 1/2/3; Influenza virus A/B;H1N1 virus; Severe Acute Respiratory Syndrome (SARS) -related coronavirus
Cough, Shortness of Breath (SOB), fever, chest pain, dyspnea on exertion, leukopenia, leukocytosis, increased Lactate Dehydrogenase (LDH), respiratory failure, pneumonia (including presumed atypical etiologies), pleural effusion, abnormal Liver Function Tests (LFT), hoarseness, “whooping cough,” bronchitis, chronic cough, hemoptysis, abnormal sputum, coma, malaise, fatigue, anorexia, headache, wheezing, respiratory distress, abnormal chest sounds, erythema multiforme, Stevens-Johnson syndrome, cold agglutinin disease, Raynaud’s syndrome, non-specific skin rashes
Central Nervous System
Herpes simplex virus; Cytomegalovirus (CMV); Enterovirus
Toxoplasma gondii;Varicella-Zoster Virus (VZV) ; West Nile virus
Fever, headache, seizure, photophobia, altered mental status, coma, delirium, abnormal Computed Tomography (CT) of the head, abnormal chemistry, abnormal Complete Blood Count (CBC), genital lesion plus headache, alteration of consciousness, hallucination, meningismus, abnormal spinal fluid, leukopenia, leukocytosis, hepatitis, pneumonia, skin lesions (genital or other), erythema multiforme, Stevens-Johnson syndrome, viremia
Transplantation/ Immuno-compromised
Herpes virus-6; CMV
Epstein-Barr virus; VZV; Polyomavirus (JC/BK); HTLV-1;Herpes virus-7
Fever, leukopenia, fatigue, abnormal LFT, elevated creatinine, signs and symptoms of rejection, altered mental status, pneumonitis, retinitis, encephalitis, hepatitis, “viral syndrome,” colitis, esophagitis, post-transplant lymphoproliferative disease, hepatosplenomegaly, nephropathy, hemorrhagic cystitis, hematuria, abnormal urine sediment, abnormal CT, altered vision, loss of vision, “floaters,” CNS lymphoma, lymphadenopathy, brain mass
HIV
HIV-1; HIV-2
N/A
Hepatitis
Hepatitis B, C and G
N/A
Mycobacteria
M. tuberculosis; M. avium-intracellulare;Mycobacterial species
N/A
Fever, night sweats, weight loss, fatigue, SOB, cough, abnormal chest X-ray/CT, including miliary pattern, abnormal LFT, cavitary lesions, anorexia, hemoptysis, myalgias, hematuria, vaginal bleeding, abdominal pain, obstruction, neck mass, lymphadenopathy, abnormal sputum, abdominal mass, ascites, leukocytosis, leukopenia
Cervicitis/ Urethritis/ Vaginitis
Chlamydia trachomatis; Neisseria gonorrhoeae; Gardnerella vaginalis; Trichomonas vaginalis;Candida species
N/A
Genital ulcers, genital lesions, urethritis, vaginitis, cervicitis, Pelvic Inflammatory Disease (PID), Reiter’s disease, pelvic/peritoneal adhesions (Fitzhugh-Curtis syndrome), infertility of tubal origin,abdominal pain, abdominal tenderness, vaginal discharge, dysuria, salpingitis, epididymitis, prostatitis, proctitis, pharyngitis, orchitis, genital discharge, rash, tenosynovitis, arthritis, arthralgias, bacteremia, fever, quadrant pain, abnormal LFT, abnormal urine, leukocytosis, leukopenia, lymphadenopathy and lymphadenitis, acute/chronic conjunctivitis
Abnormal Pap Smear
Papillomavirus
N/A
Atypical Squamous Cell Changes of Undetermined Significance (ASCUS), atypical glandular cell changes of undetermined significance, Low-Grade Squamous Intraepithelial Dysplasia (LGSIL)
Possible Group A Streptococcal Infection
Streptococcus, Group A
N/A
Sore throat, acute pharyngitis, acute nasopharyngitis, fever, headache, vomiting, non-specific abdominal pain, leukocytosis, earache, rheumatic fever, endocarditis, cellulitis, tonsillitis, myositis, toxic shock, myonecrosis, acute glomerulonephritis, serum sickness
Mucocutaneous
Staphylococcus aureus;Methicillin-resistantStaphylococcus aureus;Streptococcus, Group B; Vancomycin-resistant enterococcus
N/A
Evaluating anatomic sites for carriage of pathogens
Notice: This LCD imposes diagnosis limitations that support diagnosis to procedure code automated denials. However, services performed for any given diagnosis must meet all of the indications and limitations stated in this policy, the general requirements for medical necessity as stated in CMS payment policy manuals, any and all existing CMS national coverage determinations, and all Medicare payment rules.
As published in CMS IOM 100-08, Section 13.5.1, to be covered under Medicare, a service shall be reasonable and necessary. When appropriate, contractors shall describe the circumstances under which the proposed LCD for the service is considered reasonable and necessary under Section 1862(a)(1)(A). Contractors shall consider a service to be reasonable and necessary if the contractor determines that the service is:
  • Safe and effective.
  • Not experimental or investigational (exception: routine costs of qualifying clinical trial services with dates of service on or after September 19, 2000, which meet the requirements of the clinical trials NCD are considered reasonable and necessary).
  • Appropriate, including the duration and frequency that is considered appropriate for the service, in terms of whether it is:
    • Furnished in accordance with accepted standards of medical practice for the diagnosis or treatment of the patient’s condition or to improve the function of a malformed body member.
    • Furnished in a setting appropriate to the patient’s medical needs and condition.
    • Ordered and furnished by qualified personnel.
    • One that meets, but does not exceed, the patient’s medical need.
    • At least as beneficial as an existing and available medically appropriate alternative.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
12X, 13X, 14X, 18X, 21X, 22X, 23X, 71X, 72X, 73X, 75X, 77X, 83X, 85X
Bill Type Note: Code 73X end-dated for Medicare use March 31, 2010; code 77X effective for dates of service on or after April 1, 2010.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.
Note: TrailBlazer has identified the Bill Type and Revenue Codes applicable for use with the CPT/HCPCS codes included in this LCD. Providers are reminded that not all CPT/HCPCS codes listed can be billed with all Bill Type and/or Revenue Codes listed. CPT/HCPCS codes are required to be billed with specific Bill Type and Revenue Codes. Providers are encouraged to refer to the CMS Internet-Only Manual (IOM) Pub. 100-04, Claims Processing Manual, for further guidance.
030X, 031X
CPT/HCPCS Codes

Note:

Providers are reminded to refer to the long descriptors of the CPT Codes in their CPT book. The AMA and CMS require the use of short CPT descriptors in policies published on the Web.
87260©
Adenovirus, immunofluorescent technique
87280©
Respiratory syncytial virus, immunofluorescent technique
87471©
Bartonella, amp probe
87476©
Lyme dis, amp probe
87480©
Candida, dir probe
87486©
Chylmd pneum, amp probe
87490©
Chylmd trach, dir probe
87491©
Chylmd trach, amp probe
87496©
Cytomeg, amp probe
87497©
Cytomeg, quant
87498©
Enterovirus, dna, amp probe
87500©
Vanomycin, dna, amp probe
87501©
Influenza dna amp prob 1+
87502©
Influenza dna amp probe
87503©
Influenza dna amp prob addl
87510©
Gardner vag, dir probe
87516©
Hepatitis b, amp probe
87517©
Hepatitis b, quant
87521©
Hepatitis c, amp probe
87522©
Hepatitis c, quant
87526©
Hepatitis g, amp probe
87529©
Hsv, amp probe
87532©
Hhv-6, amp probe
87534©
Hiv-1, dir probe
87535©
Hiv-1, amp probe
87536©
Hiv-1, quant
87537©
Hiv-2, dir probe
87538©
Hiv-2, amp probe
87539©
Hiv-2, quant
87541©
Legion pneumo, amp probe
87551©
Mycobacteria, amp probe
87556©
M.tuberculo, amp probe
87561©
M.avium-intra, amp probe
87581©
M.pneumon, amp probe
87590©
N.gonorrhoeae, dir probe
87591©
N.gonorrhoeae, amp probe
87621©
Hpv, amp probe
87640©
Staph a, dna, amp probe
87641©
Mr-staph, dna, amp probe
87650©
Strep a, dir probe
87653©
Strep b, dna, amp probe
87660©
Trichomonas vagin, dir probe
87797©
Detect agent nos, dir probe
87798©
Detect agent nos, amp probe
87799©
Detect agent nos, quant
87901©
Genotype, hiv reverse t
87902©
Genotype, hepatitis c
87903©
Phenotype, hiv w/culture
87904©
Phenotype, hiv w/clt add
87906©
Genotype dna hiv reverse t
ICD-9-CM Codes That Support Medical Necessity
The CPT/HCPCS codes included in this LCD will be subjected to “procedure to diagnosis” editing. The following lists include only those diagnoses for which the identified CPT/HCPCS procedures are covered. If a covered diagnosis is not on the claim, the edit will automatically deny the service as not medically necessary.
Medicare is establishing the following limited coverage for CPT/HCPCS codes 87471, 87476, 87480, 87486, 87490, 87491, 87496, 87497, 87498, 87500, 87510, 87516, 87517, 87521, 87522, 87526, 87529, 87532, 87534, 87535, 87536, 87537, 87538, 87539, 87541, 87551, 87556, 87561, 87581, 87590, 87591, 87621, 87640, 87641, 87650, 87653, 87660, 87797, 87798, 87799, 87901, 87902, 87903 and 87904:
List A
Medicare is establishing the following limited coverage for Bartonella henselae and Bartonella quintana (87471),Borrelia burgdorferi (87476), enterovirus (87498), herpes virus-6 (87532), Parvovirus B19 (87799) and (87798) for the following organisms - Ehrlichia species, herpes virus-7, West Nile virus, Leishmania species, Parvovirus B19 andBabesia species:
Covered for:
040.89
Other specified bacterial diseases, other
058.10–058.12
Roseola infantum
058.81–058.82
Human herpesvirus infection
058.89
Other human herpesvirus infection
078.3
Cat-scratch disease
079.83
Parvovirus B19
087.0–087.1
Relapsing fever
087.9
Relapsing fever, unspecified
088.0
Bartonellosis
088.81
Lyme Disease
287.41
Posttransfusion purpura
287.49
Other secondary thrombocytopenia
287.5
Thrombocytopenia, unspecified
288.00–288.04
Neutropenia
288.09
Other neutropenia
288.66
Bandemia
288.8
Other specified disease of white blood cells
320.9
Meningitis due to unspecified bacterium
322.9
Meningitis, unspecified
323.01–323.02
Encephalitis, myelitis, and encephalomyelitis in viral diseases, classified elsewhere
323.41–323.42
Other encephalitis, myelitis, and encephalomyelitis due to infection, classified elsewhere
323.51–323.52
Encephalitis, myelitis, and encephalomyelitis following immunization procedures
323.61–323.63
Postinfectious encephalitis, myelitis, and encephalomyelitis
323.81–323.82
Other causes of encephalitis, myelitis, and encephalomyelitis
323.9
Unspecified causes of encephalitis, myelitis, and encephalomyelitis
351.0
Bell’s palsy
421.0–421.1
Acute and subacute endocarditis
421.9
Acute endocarditis, unspecified
424.0–424.3
Other diseases of endocardium
424.90–424.91
Endocarditis, valve unspecified
424.99
Other endocarditis, valve unspecified
426.0
Atrioventricular block, complete
426.10–426.13
Atrioventricular block, other and unspecified
426.2–426.4
Conduction disorders
426.50–426.54
Bundle branch block, other and unspecified
426.6–426.7
Conduction disorders
426.81–426.82
Other specified conduction disorders
426.89
Other specified conduction disorders
426.9
Conduction disorder, unspecified
573.9
Unspecified disorder of liver
719.40–719.49
Pain in joint
729.1
Myalgia and myositis, unspecified
780.32
Complex febrile convulsions
780.60–780.61
Fever
780.79
Other malaise and fatigue
781.6
Meningismus
782.1
Symptom, rash and other non-specific skin eruption
783.0
Symptoms, anorexia
784.0
Headache
785.50
Shock, unspecified
785.6
Enlargement of lymph nodes
999.31
Infection due to central venous catheter
999.39
Infection following other infusion, injection, transfusion, or vaccination
List B
Medicare is establishing the following limited coverage for adenovirus (87260), respiratory syncytial virus(87280),Chlamydia pneumoniae (87486), influenza virus A/B (87501, 87502 and 87503), Legionella pneumophila(87541), Mycoplasma pneumoniae (87581) and (87798) for the following organisms - Bordetella pertussis,parainfluenza virus 1/2/3, SARS-related coronavirus and H1N1 virus:
Covered for:
283.0
Autoimmune hemolytic anemias
288.00–288.04
Neutropenia
288.09
Other neutropenia
288.66
Bandemia
288.8
Other specified disease of white blood cells
466.0
Acute bronchitis
482.84
Pneumonia due to Legionnaires’ disease
482.9
Bacterial pneumonia, unspecified
483.0–483.1
Pneumonia due to other specified organism
486
Pneumonia, organism unspecified
488.01
Influenza due to identified avian influenza virus with pneumonia
488.02
Influenza due to identified avian influenza virus with other respiratory manifestations
488.09
Influenza due to identified avian influenza virus with other manifestations
488.11
Influenza due to identified novel H1N1 influenza virus with pneumonia
488.12
Influenza due to identified novel H1N1 influenza virus with other respiratory manifestations
488.19
Influenza due to identified novel H1N1 influenza virus with other manifestations
490
Bronchitis, not specified as acute or chronic
511.89
Other specified forms of effusion, except tuberculous
511.9
Unspecified pleural effusion
518.81
Acute respiratory failure
518.83–518.84
Other diseases of lung
695.10–695.15
Erythema multiforme
695.19
Other erythema multiforme
780.01
Coma
780.79
Other malaise and fatigue
782.1
Symptom, rash and other non-specific skin eruption
783.0
Symptoms, anorexia
784.0
Headache
784.49
Other voice and resonance disorders
786.05
Shortness of breath
786.07
Wheezing
786.09
Other dyspnea and respiratory abnormality
786.2
Cough
786.39
Other hemoptysis
786.50–786.52
Chest pain
786.59
Other chest pain
790.4–790.5
Abnormal glucose
List C
Medicare is establishing the following limited coverage for cytomegalovirus (87496), enterovirus (87498), herpes simplex virus (87529) and (87798) for the following organisms - toxoplasma gondii, West Nile virus and Varicella-zoster virus:
Covered for:
054.3
Herpetic meningoencephalitis
054.72
Herpes simplex meningitis
054.74
Herpes simplex myelitis
058.21
Human herpesvirus 6 encephalitis
058.29
Other human herpesvirus encephalitis
288.00–288.04
Neutropenia
288.09
Other neutropenia
288.66
Bandemia
288.8
Other specified disease of white blood cells
293.0–293.1
Transient mental disorders due to conditions classified elsewhere
345.90–345.91
Epilepsy, unspecified
368.13
Visual discomfort
486
Pneumonia, organism unspecified
573.9
Unspecified disorder of liver
608.89
Other specified disorders of male genital organs, other
629.89
Other specified disorders of female genital organs
695.10–695.15
Erythema multiforme
695.19
Other erythema multiforme
709.9
Unspecified disorder of skin and subcutaneous tissue
780.01–780.03
Alternation of consciousness
780.09
Other alteration of consciousness
780.1
Hallucinations
780.32
Complex febrile convulsions
780.60–780.61
Fever
781.6
Meningismus
789.00–789.07
Abdominal pain
789.09
Abdominal pain, other specified site
790.8
Viremia, unspecified
792.0
Non-specific abnormal findings in cerebrospinal fluid
List D
Medicare is establishing the following limited coverage for Cytomegalovirus (87496, 87497), Herpes virus-6 (87532),(87798) for the following organisms -, Herpes virus-7, Epstein-Barr virus, Varicella-zoster virus, Polyomavirus [JC/BK] and (87799) for the following organisms - Epstein-Barr virus HTLV-1 and Polyomavirus [JC/BK]:
Covered for:
009.1
Colitis, enteritis, and gastroenteritis of presumed infectious origin
058.81–058.82
Human herpesvirus infection
058.89
Other human herpesvirus infection
078.5
Cytomegaloviral disease
200.00–200.08
Reticulosarcoma
200.10–200.18
Lymphosarcoma
200.20–200.28
Burkitt’s tumor or lymphoma
200.30–200.38
Marginal zone lymphoma
200.40–200.48
Mantle cell lymphoma
200.50–200.58
Primary central nervous system lymphoma
200.60–200.68
Anaplastic large cell lymphoma
200.70–200.78
Peripheral T cell lymphoma
200.80–200.88
Other named variants
201.00–201.08
Hodgkin’s paragranuloma
201.10–201.18
Hodgkin’s granuloma
201.20–201.28
Hodgkin’s sarcoma
201.40–201.48
Lymphocytic-histiocytic predominance
201.50–201.58
Nodular sclerosis
201.60–201.68
Mixed cellularity
201.70–201.78
Lymphocytic depletion
201.90–201.98
Hodgkin’s disease, unspecified
202.00–202.08
Nodular lymphoma
202.10–202.18
Mycosis fungoides
202.20–202.28
S├ęzary’s disease
202.30–202.38
Malignant histiocytosis
202.40–202.48
Leukemic reticuloendotheliosis
202.50–202.58
Letterer-Siwe disease
202.60–202.68
Malignant mast cell tumors
202.70-202.78
Peripheral T cell lymphoma
202.80–202.88
Other lymphomas
202.90–202.98
Other and unspecified malignant neoplasms of lymphoid and histiocytic tissue
238.72–238.75
Neoplasm of uncertain behavior of other lymphatic and hematopoietic tissues
238.77
Post-transplant lymphoproliferative disorder (PTLD)
288.00–288.04
Neutropenia
288.09
Other neutropenia
288.66
Bandemia
288.8
Other specified disease of white blood cells
323.01–323.02
Encephalitis, myelitis, and encephalomyelitis in viral diseases, classified elsewhere
323.41–323.42
Other encephalitis, myelitis, and encephalomyelitis due to infection, classified elsewhere
323.51–323.52
Encephalitis, myelitis, and encephalomyelitis following immunization procedures
323.61–323.63
Postinfectious encephalitis, myelitis, and encephalomyelitis
323.81–323.82
Other causes of encephalitis, myelitis, and encephalomyelitis
323.9
Unspecified causes of encephalitis, myelitis, and encephalomyelitis
363.00–363.01
Focal chorioretinitis and focal retinochoroiditis
363.03–363.08
Focal chorioretinitis and focal retinochoroiditis
363.10–363.15
Disseminated chorioretinitis and disseminated retinochoroiditis
368.40–368.47
Visual field defects
368.8–368.9
Visual disturbances
480.8
Pneumonia due to other virus not elsewhere classified
484.1
Pneumonia in cytomegalic inclusion disease
530.10–530.12
Esophagitis
530.19
Other esophagitis
573.9
Unspecified disorder of liver
583.9
Nephritis and nephropathy, not specified as acute or chronic, with unspecified pathological lesion in kidney
586
Renal failure, unspecified
595.9
Cystitis, unspecified
599.70–599.72
Hematuria
771.1
Congenital cytomegalovirus infection
780.01–780.03
Alteration of consciousness
780.09
Other alteration of consciousness
780.32
Complex febrile convulsions
780.60–780.61
Fever
780.79
Other malaise and fatigue
784.2
Swelling, mass, or lump in head and neck
785.6
Enlargement of lymph nodes
789.1–789.2
Other symptoms involving abdomen and pelvis
790.4
Non-specific elevation of levels of transaminase or lactic acid dehydrogenase (LDH)
790.5
Other non-specific abnormal serum enzyme levels
791.0–791.7
Nonspecific findings on examination of urine
791.9
Other non-specific findings on examination of urine
996.80–996.87
Complications of unspecified transplanted organ
996.89
Complications of other specified transplanted organ
V42.0
Organ or tissue replaced by transplant, kidney
V42.6
Organ or tissue replaced by transplant, lung
V42.81
Organ or tissue replaced by transplant, bone marrow
V42.82
Peripheral stem cells replaced by transplant
List E
Medicare is establishing the following limited coverage for HIV diagnosis and prognosis, including monitoring (87534, 87535, 87536, 87537, 87538 and 87539):

Covered for:

Documentation in the Federal Register (Federal Register Final Rules (11/23/01)) includes the initial list(s) of ICD-9-CM Diagnosis Codes. Documentation in the NCD Coding Manual Releases (posted by date) includes updated list(s) of ICD-9-CM Diagnosis Codes. To ensure appropriate coding, providers must review ALL the documents.
List F
Medicare is establishing the following limited coverage for HIV genotyping and phenotyping (87901, 87903, 87904and 87906):

Covered for:

042
Human Immunodeficiency Virus (HIV) Disease
079.53
Human Immunodeficiency Virus Type 2 [Hiv-2]
647.60–647.64
Other Viral Diseases Of Mother Complicating Pregnancy Childbirth Or The Puerperium
795.71
Nonspecific Serologic Evidence Of Human Immunodeficiency Virus (Hiv)
V08
Asymptomatic Human Immunodeficiency Virus (Hiv) Infection Status
List G
Medicare is establishing the following limited coverage for hepatitis B, C and G testing (87516, 87517, 87521, 87522 and 87526):
Covered for:
070.20–070.23
Viral hepatitis b with hepatic coma
070.30–070.33
Viral hepatitis b without mention of hepatic coma
070.41
Acute hepatitis c with hepatic coma
070.44
Chronic hepatitis c with hepatic coma
070.49
Other specified viral hepatitis with hepatic coma
070.51
Acute hepatitis c without hepatic coma
070.54
Chronic hepatitis c without hepatic coma
070.59
Other specified viral hepatitis without hepatic coma
070.6
Unspecified viral hepatitis with hepatic coma
070.70–070.71
Unspecified viral hepatitis C
070.9
Unspecified viral hepatitis without hepatic coma
456.0–456.1
Varicose veins of other sites, esophageal varices
456.20–456.21
Esophageal varices in diseases classified elsewhere
570
Acute and subacute necrosis of liver
571.5
Cirrhosis of liver without alcohol
572.0–572.4
Liver abscess and sequelae of chronic liver disease
572.8
Other sequelae of chronic liver disease
573.3
Hepatitis unspecified
780.31–780.32
Febrile convulsions
780.71
Chronic fatigue syndrome
780.79
Other malaise and fatigue
782.4
Jaundice unspecified not of newborn
783.0–783.1
Symptoms concerning nutrition, metabolism and development
783.21–783.22
Abnormal loss of weight and underweight
783.3
Feeding difficulties and mismanagement
783.40–783.43
Lack of expected normal physiological development in childhood
783.5–783.6
Symptoms concerning nutrition, metabolism and development
784.69
Other symbolic dysfunction
787.01–787.03
Nausea and vomiting
789.00–789.07
Other symptoms involving abdomen and pelvis
789.09
Other symptoms involving abdomen and pelvis, other specified site
789.1
Hepatomegaly
789.61
Abdominal tenderness right upper quadrant
794.8
Nonspecific abnormal results of function study of liver
996.82
Complications of transplanted liver
999.31
Infection due to central venous catheter
999.39
Infection following other infusion, injection, transfusion, or vaccination
V72.85
Other specified examination
List H
Medicare is establishing the following limited coverage for hepatitis C genotyping (87902):

Covered for:

070.41
Acute hepatitis C with hepatic coma
070.44
Chronic hepatitis C with hepatic coma
070.51
Acute hepatitis C without mention of hepatic coma
070.54
Chronic hepatitis C without mention of hepatic coma
070.70–070.71
Unspecified viral hepatitis C
288.00288.04
Neutropenia
288.09
Other neutropenia
288.66
Bandemia
288.8
Other specified disease of white blood cells
571.41
Chronic persistent hepatitis
List I
Medicare is establishing the following limited coverage for mycobacterium tuberculosis (87556), mycobacterium avium-intracellulare (87561) and other mycobacteria species (87551):

Covered for:

010.00–010.06
Primary tuberculous complex
010.10–010.16
Tuberculous pleurisy in primary progressive tuberculosis
010.80–010.86
Other primary progressive tuberculosis
010.90–010.96
Primary tuberculous infection, unspecified
011.00–011.06
Tuberculosis of lung, infiltrative
011.10–011.16
Tuberculosis of lung, nodular
011.20–011.26
Tuberculosis of lung with cavitation
011.30–011.36
Tuberculosis of bronchus
011.40–011.46
Tuberculous fibrosis of lung
011.50–011.56
Tuberculous bronchiectasis
011.60–011.66
Tuberculous pneumonia [any form]
011.70–011.76
Tuberculous pneumothorax
011.80–011.86
Other specified pulmonary tuberculosis
011.90–011.96
Pulmonary tuberculosis, unspecified
012.00–012.06
Tuberculous pleurisy
012.10–012.16
Tuberculosis of intrathoracic lymph nodes
012.20–012.26
Isolated tracheal or bronchial tuberculosis
012.30–012.36
Tuberculous laryngitis
012.80–012.86
Other specified respiratory tuberculosis
013.00–013.06
Tuberculous meningitis
013.10–013.16
Tuberculoma of meninges
013.20–013.26
Tuberculoma of brain
013.30–013.36
Tuberculous abscess of brain
013.40–013.46
Tuberculoma of spinal cord
013.50–013.56
Tuberculous abscess of spinal cord
013.60–013.66
Tuberculous encephalitis or myelitis
013.80–013.86
Other specified tuberculosis of central nervous system
013.90–013.96
Unspecified tuberculosis of central nervous system
014.00–014.06
Tuberculous peritonitis
014.80–014.86
Other Tuberculosis of intestines, peritoneum, and mesenteric glands
015.00–015.06
Vertebral column
015.10–015.16
Tuberculosis of hip
015.20–015.26
Tuberculosis of knee
015.50–015.56
Tuberculosis of limb bones
015.60–015.66
Tuberculosis of mastoid
015.70–015.76
Tuberculosis of other specified bone
015.80–015.86
Tuberculosis of other specified joint
015.90–015.96
Tuberculosis of unspecified bones and joints
016.00–016.06
Tuberculosis of kidney
016.10–016.16
Tuberculosis of bladder
016.20–016.26
Tuberculosis of ureter
016.30–016.36
Tuberculosis of other urinary organs
016.40–016.46
Tuberculosis of epididymis
016.50–016.56
Tuberculosis of other male genital organs
016.60–016.66
Tuberculous oophoritis and salpingitis
016.70–016.76
Tuberculosis of other female genital organs
016.90–016.96
Unspecified genitourinary tuberculosis
017.00–017.06
Tuberculosis of skin and subcutaneous cellular tissue
017.10–017.16
Erythema nodosum with hypersensitivity reaction in tuberculosis
017.20–017.26
Tuberculosis of peripheral lymph nodes
017.30–017.36
Tuberculosis of eye
017.40–017.46
Tuberculosis of ear
017.50–017.56
Tuberculosis of thyroid gland
017.60–017.66
Tuberculosis of adrenal glands
017.70–017.76
Tuberculosis of spleen
017.80–017.86
Tuberculosis of esophagus
017.90–017.96
Tuberculosis of other specified organs
018.00–018.06
Acute miliary tuberculosis
018.80–018.86
Other specified miliary tuberculosis
018.90–018.96
Unspecified miliary tuberculosis, unspecified
031.0–031.2
Pulmonary diseases due to other mycobacteria
031.8–031.9
Pulmonary diseases due to other mycobacteria
288.00–288.04
Neutropenia
288.09
Other neutropenia
288.66
Bandemia
288.8
Other specified disease of white blood cells
560.9
Unspecified intestinal obstruction
599.70–599.72
Hematuria
626.8–626.9
Disorders of menstruation and other abnormal bleeding from female genital tract
729.1
Myalgia and myositis, unspecified
780.32
Complex febrile convulsions
780.60–780.61
Fever
780.79
Other malaise and fatigue
780.8
Hyperhidrosis
783.0
Symptoms, anorexia
783.21
Symptoms, abnormal loss of weight
784.2
Swelling, mass, or lump in head and neck
785.6
Enlargement of lymph nodes
786.02
Orthopnea
786.05
Shortness of breath
786.39
Other hemoptysis
789.00–789.07
Abdominal pain
789.09
Abdominal pain, other specified site
789.1–789.2
Other symptoms involving abdomen and pelvis
789.30–789.37
Abdominal or pelvic swelling, mass, or lump
789.39
Abdominal or pelvic swelling, mass, or lump, other specified site
789.51
Malignant ascites
789.59
Other ascites
List J
Medicare is establishing the following limited coverage for Chlamydia trachomatis (87490, 87491), Neisseria gonorrhoeae (87590, 87591), Candida species (87480), Gardnerella vaginalis (87510) and Trichomonas vaginalis(87660):
Covered for:
076.0–076.1
Trachoma
076.9
Trachoma, unspecified
077.0
Inclusion conjunctivitis
077.98–077.99
Unspecified diseases of conjunctiva due to viruses and Chlamydiae
098.0
Gonococcal infection (acute) of lower genitourinary tract
098.10–098.17
Acute of upper genitourinary tract
098.19
Other gonococcal infection (acute) of upper genitourinary tract
098.2
Gonococcal infection, chronic, of lower genitourinary tract
098.30–098.37
Chronic, of upper genitourinary tract
098.39
Other chronic gonococcal infection of upper genitourinary tract
098.40–098.43
Gonococcal infection of eye
098.49
Other gonococcal infection of eye
098.50–098.53
Gonococcal infection of joint
098.59
Other gonococcal infection of joint
098.6–098.7
Gonococcal infections
098.81–098.86
Gonococcal infection of other specified sites
098.89
Gonococcal infection of other specified sites, other
099.1
Lymphogranuloma venereum
099.3
Reiter’s disease
099.41
Veneral urethritis due to Chlamydia trachomatis
099.50–099.56
Other venereal diseases due to Chlamydia trachomatis
099.59
Chlamydia trachomatis infection of other specified site
112.1–112.2
Candidiasis
131.00–131.03
Urogenital trichomoniasis
131.09
Other urogenital trichomoniasis
131.8–131.9
Trichomoniasis
288.00–288.04
Neutropenia
288.09
Other neutropenia
288.66
Bandemia
288.8
Other specified disease of white blood cells
289.1
Chronic lymphadenitis
289.53
Neutropenic splenomegaly
289.83
Myelofibrosis
372.00
Acute conjunctivitis, unspecified
372.02–372.03
Acute conjunctivitis
372.10–372.12
Chronic conjunctivitis
595.4
Cystitis in diseases classified elsewhere
597.80–597.81
Other urethritis
601.0
Acute prostatitis
601.8–601.9
Inflammatory diseases of prostate
604.0
Orchitis, epididymitis, and epididymo-orchitis, with abscess
604.90–604.91
Other orchitis, epididymitis, and epididymitis- orchitis, without mention of abscess
608.89
Other specified disorders of male genital organs, other
614.0
Acute salpingitis and oophoritis
614.2–614.4
Inflammatory disease of ovary, fallopian tube, pelvic cellular tissue, and peritoneum
614.6
Pelvic peritoneal adhesions, female
614.8–614.9
Inflammatory disease of ovary, fallopian tube, pelvic cellular tissue, and peritoneum
616.0
Cervicitis and endocervicitis
616.10–616.11
Vaginitis and vulvovaginitis
616.81
Mucositis (ulcerative) of cervix, vagina, and vulva
616.89
Other inflammatory disease of cervix, vagina and vulva
616.9
Unspecified inflammatory diseases of cervix, vagina, and vulva
628.2
Infertility, female, of tubal origin
629.89
Other specified disorders of female genital organs
683
Acute lymphadenitis
711.90–711.99
Unspecified infective arthritis
716.50–716.59
Unspecified polyarthropathy or polyarthritis
716.60–716.68
Unspecified monoarthritis
716.90–716.99
Arthropathy, unspecified
719.40–719.49
Pain in joint
727.00
Synovitis and tenosynovitis, unspecified
727.05–727.06
Synovitis and tenosynovitis, unspecified
727.09
Other synovitis and tenosynovitis
771.6
Neonatal conjunctivitis and dacryocystitis
780.60–780.61
Fever
782.1
Symptom, rash and other non-specific skin eruption
785.6
Enlargement of lymph nodes
788.1
Dysuria
788.64–788.65
Other abnormality of urination
788.7
Urethral discharge
789.00–789.07
Abdominal pain
789.09
Abdominal pain, other specified site
789.1–789.2
Other symptoms involving abdominal and pelvic
789.30–789.37
Abdominal or pelvic swelling, mass, or lump
789.39
Abdominal or pelvic swelling, mass, or lump, other specified site
789.40–789.47
Abdominal rigidity
789.49
Abdominal rigidity, other specified site
789.51
Malignant ascites
789.59
Other ascites
789.60–789.67
Abdominal tenderness
789.69
Abdominal tenderness, other specified site
789.9
Other symptoms involving abdomen and pelvis
790.4–790.5
Nonspecific findings on examination of blood
790.7
Bacteremia
791.0–791.7
Nonspecific findings on examination of urine
791.9
Other non-specific findings on examination of urine
List K
Medicare is establishing the following limited coverage for human papillomavirus (87621):
Covered for:
622.10–622.12
Dysplasia of cervix (uteri)
795.00–795.01
Abnormal Papanicolaou smear of cervix and cervix HPV
795.03
Papanicolaou smear of cervix with low grade squamous intraepithelial lesion (LGSIL)
List L
Medicare is establishing the following limited coverage for Group A Streptococcus (87650):
Covered for:
034.0–034.1
Streptococcal sore throat and scarlet fever
040.0
Gas gangrene
040.82
Toxic shock syndrome
288.66
Bandemia
288.8
Other specified disease of white blood cells
388.70
Otalgia, unspecified
388.72
Otalgia, referred pain
390
Rheumatic fever without mention of heart involvement
391.0–391.2
Rheumatic fever with heart involvement
391.8–391.9
Rheumatic fever with heart involvement
421.0–421.1
Acute and subacute endocarditis
421.9
Acute endocarditis, unspecified
460
Acute nasopharyngitis [common cold]
462
Acute pharyngitis
463
Acute tonsillitis
580.0
Acute glomerulonephritis, with lesion of proliferative glomerulonephritis
580.4
Acute glomerulonephritis, with lesion of rapidly progressive glomerulonephritis
580.81
Acute glomerulonephritis in diseases classified elsewhere
580.89
Acute glomerulonephritis with other specified pathological lesion in kidney
580.9
Acute glomerulonephritis with unspecified pathological lesion in kidney
681.00–681.02
Cellulitis and abscess of finger
681.10–681.11
Cellulitis and abscess of toe
681.9
Cellulitis and abscess of unspecified digit
682.0–682.9
Other cellulitis and abscess
728.0
Infective myositis
780.32
Complex febrile convulsions
780.60–780.61
Fever
784.0
Headache
787.03
Vomiting alone
789.00
Abdominal pain, unspecified site
999.5
Other serum reaction
List M
Medicare is establishing the following limited coverage for Staphylococcus aureus (87640), Methicillin-resistantStaphylococcus aureus (87641), Group B Streptococcus (87653) and Vancomycin-resistant Enterococcus (87500):
Covered for:

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