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44397 | Colonoscopy w/stent | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. Computed tomography (CT) colonography should be performed with a minimum 16-row detector CT scanner. Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. |
0067T | Ct Colonography;Dx | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. Computed tomography (CT) colonography should be performed with a minimum 16-row detector CT scanner. Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. |
45338 | SIG.SCOPE W SNARE REMOVAL | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. Computed tomography (CT) colonography should be performed with a minimum 16-row detector CT scanner. Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. |
45387 | Colonoscopy w/stent | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. Computed tomography (CT) colonography should be performed with a minimum 16-row detector CT scanner. Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. |
. | Albumin VIAL 5% 12.5g/250 mL | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. Computed tomography (CT) colonography should be performed with a minimum 16-row detector CT scanner. Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. |
G0102 | PR PROSTATE CA SCREENING; DRE | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. Computed tomography (CT) colonography should be performed with a minimum 16-row detector CT scanner. Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. |
45333 | SIG.SCOPE W HOT BX RMV | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. Computed tomography (CT) colonography should be performed with a minimum 16-row detector CT scanner. Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. |
45383 | Lesion removal colonoscopy | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. Computed tomography (CT) colonography should be performed with a minimum 16-row detector CT scanner. Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. |
44394 | PR COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. Computed tomography (CT) colonography should be performed with a minimum 16-row detector CT scanner. Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. |
45385 | Removal of polyps or growths of large bowel using an endoscope with mechanical snare | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. Computed tomography (CT) colonography should be performed with a minimum 16-row detector CT scanner. Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. |
45332 | Sigmoidoscopy w/fb removal | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. Computed tomography (CT) colonography should be performed with a minimum 16-row detector CT scanner. Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. |
45307 | PR PROCTOSGMDSC RIGID W/RMVL FOREIGN BODY | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. Computed tomography (CT) colonography should be performed with a minimum 16-row detector CT scanner. Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. |
G0121 | SCRN COLONOSCOPY PT NOT HI RISK | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. Computed tomography (CT) colonography should be performed with a minimum 16-row detector CT scanner. Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. |
44390 | PR COLONOSCOPY STOMA W/RMVL FOREIGN BODY | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. Computed tomography (CT) colonography should be performed with a minimum 16-row detector CT scanner. Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. |
45384 | Removal of polyps or growths of large bowel using a flexible endoscope with electrical cautery | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. Computed tomography (CT) colonography should be performed with a minimum 16-row detector CT scanner. Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. |
44393 | Colonoscopy lesion removal | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. Computed tomography (CT) colonography should be performed with a minimum 16-row detector CT scanner. Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. |
45339 | Sigmoidoscopy w/ablate tumr | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. Computed tomography (CT) colonography should be performed with a minimum 16-row detector CT scanner. Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. |
45345 | Sigmoidoscopy w/stent | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. Computed tomography (CT) colonography should be performed with a minimum 16-row detector CT scanner. Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. |
44392 | PR COLONOSCOPY STOMA RMVL LES BY HOT BIOPSY FORCEPS | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. Computed tomography (CT) colonography should be performed with a minimum 16-row detector CT scanner. Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. |
0066T | Ct Colonography;Screen | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. Computed tomography (CT) colonography should be performed with a minimum 16-row detector CT scanner. Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. |
1999 | ANESTHESIOLOGY GROUP | CPT | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. Computed tomography (CT) colonography should be performed with a minimum 16-row detector CT scanner. Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. |
45382 | PR COLSC FLEXIBLE W/CONTROL BLEEDING ANY METHOD | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. Computed tomography (CT) colonography should be performed with a minimum 16-row detector CT scanner. Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. |
G0328 | PR FECAL BLOOD SCRN IMMUNOASSAY | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. Computed tomography (CT) colonography should be performed with a minimum 16-row detector CT scanner. Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. |
44397 | Colonoscopy w/stent | HCPCS | Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. |
0067T | Ct Colonography;Dx | HCPCS | Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. |
45338 | SIG.SCOPE W SNARE REMOVAL | HCPCS | Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. |
45387 | Colonoscopy w/stent | HCPCS | Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. |
. | Albumin VIAL 5% 12.5g/250 mL | HCPCS | Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. |
G0102 | PR PROSTATE CA SCREENING; DRE | HCPCS | Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. |
45333 | SIG.SCOPE W HOT BX RMV | HCPCS | Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. |
45383 | Lesion removal colonoscopy | HCPCS | Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. |
44394 | PR COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE | HCPCS | Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. |
45385 | Removal of polyps or growths of large bowel using an endoscope with mechanical snare | HCPCS | Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. |
45332 | Sigmoidoscopy w/fb removal | HCPCS | Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. |
45307 | PR PROCTOSGMDSC RIGID W/RMVL FOREIGN BODY | HCPCS | Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. |
G0121 | SCRN COLONOSCOPY PT NOT HI RISK | HCPCS | Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. |
44390 | PR COLONOSCOPY STOMA W/RMVL FOREIGN BODY | HCPCS | Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. |
45384 | Removal of polyps or growths of large bowel using a flexible endoscope with electrical cautery | HCPCS | Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. |
44393 | Colonoscopy lesion removal | HCPCS | Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. |
45339 | Sigmoidoscopy w/ablate tumr | HCPCS | Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. |
45345 | Sigmoidoscopy w/stent | HCPCS | Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. |
44392 | PR COLONOSCOPY STOMA RMVL LES BY HOT BIOPSY FORCEPS | HCPCS | Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. |
0066T | Ct Colonography;Screen | HCPCS | Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. |
1999 | ANESTHESIOLOGY GROUP | CPT | Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. |
45382 | PR COLSC FLEXIBLE W/CONTROL BLEEDING ANY METHOD | HCPCS | Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. |
G0328 | PR FECAL BLOOD SCRN IMMUNOASSAY | HCPCS | Contraindications to conventional colonoscopy may include continuous anticoagulation therapy or high anesthesia risk. POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. |
44397 | Colonoscopy w/stent | HCPCS | POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. |
0067T | Ct Colonography;Dx | HCPCS | POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. |
45338 | SIG.SCOPE W SNARE REMOVAL | HCPCS | POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. |
45387 | Colonoscopy w/stent | HCPCS | POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. |
. | Albumin VIAL 5% 12.5g/250 mL | HCPCS | POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. |
G0102 | PR PROSTATE CA SCREENING; DRE | HCPCS | POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. |
45333 | SIG.SCOPE W HOT BX RMV | HCPCS | POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. |
45383 | Lesion removal colonoscopy | HCPCS | POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. |
44394 | PR COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE | HCPCS | POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. |
45385 | Removal of polyps or growths of large bowel using an endoscope with mechanical snare | HCPCS | POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. |
45332 | Sigmoidoscopy w/fb removal | HCPCS | POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. |
45307 | PR PROCTOSGMDSC RIGID W/RMVL FOREIGN BODY | HCPCS | POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. |
G0121 | SCRN COLONOSCOPY PT NOT HI RISK | HCPCS | POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. |
44390 | PR COLONOSCOPY STOMA W/RMVL FOREIGN BODY | HCPCS | POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. |
45384 | Removal of polyps or growths of large bowel using a flexible endoscope with electrical cautery | HCPCS | POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. |
44393 | Colonoscopy lesion removal | HCPCS | POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. |
45339 | Sigmoidoscopy w/ablate tumr | HCPCS | POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. |
45345 | Sigmoidoscopy w/stent | HCPCS | POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. |
44392 | PR COLONOSCOPY STOMA RMVL LES BY HOT BIOPSY FORCEPS | HCPCS | POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. |
0066T | Ct Colonography;Screen | HCPCS | POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. |
1999 | ANESTHESIOLOGY GROUP | CPT | POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. |
45382 | PR COLSC FLEXIBLE W/CONTROL BLEEDING ANY METHOD | HCPCS | POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. |
G0328 | PR FECAL BLOOD SCRN IMMUNOASSAY | HCPCS | POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
3/1999: Updated to reflect national standards
2/2001: Reviewed by MPAC; Virtual colonoscopy considered investigational. Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. |
44397 | Colonoscopy w/stent | HCPCS | Healthy you guidelines will be aligned to be consistent with the American Cancer Society recommendations for early colorectal cancer detection. 5/23/2001: Code reference section revised; ICD-9 diagnosis code 235.2 and 239.0 deleted
11/14/2001: Colonoscopy and flexible sigmoidoscopy description revised under the "Description" section. 2/13/2002: Investigational definition added
3/20/2002: Revised verbiage of familial syndromes for clarity
3/26/2002: Healthy You guideline for barium enema deleted; G0121 added to non-covered
3/27/2002: Healthy You guidelines moved to Policy Exceptions
4/18/2002: Type of Service and Place of Service deleted
6/12/2002: ICD-9 diagnosis codes 235.2 and 239.0 added
7/23/2002: Policy section revised, Policy Exceptions deleted
7/30/2002: Prior authorization deleted
8/22/2002: CPT codes 44390-44397, 45332-45345, 45382-45387 deleted; ICD-9 procedure codes 45.42-45.43 deleted; ICD-9 diagnosis codes 555.9, 787.99, 799.8 deleted; ICD-9 diagnosis codes 557.1- 557.9 added; ICD-9 diagnosis code 564.89 description revised and one deleted; ICD-9 diagnosis code 556.9 is covered and non-covered depending on the description
12/11/2002: HCPCS G0102 added
11/18/2004: Reviewed by MPAC, CT colonography (“virtual colonoscopy”) remains investigational, policy title “Colonoscopy and Flexible Sigmoidoscopy” renamed “Colonoscopy, Flexible Sigmoidoscopy, and CT Colonography,” Description section updated to be consistent with BCBSA policy # 6.01.32, Sources updated
4/12/2005: Code Reference section updated, CPT code 44390, 44392, 44393, 44394, 45307, 45332, 45333, 45338, 45339, 45383, 45384, 45385 added covered codes, ICD-9 procedure code 45.42, 45.43, 98.03, 98.04 added covered codes, ICD-9 diagnosis 560.89 added covered codes, ICD-9 diagnosis codes 578.1 description revised covered codes, HCPCS G0102 deleted covered codes, HCPCS G0328 added covered codes, HCPCS 0066T, 0067T added non-covered codes, ICD-9 diagnosis code 556.9, 562.11, 562.13, 567.9, 569.49, 569.83, V72.83 deleted non-covered codes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/21/2006: Policy reviewed, no changes
09/13/2006: Coding updated. ICD9 2006 revisions added to policy
12/27/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
12/17/2007: Coding updated. CPT/HCPCS 2008 revisions added to policy
7/8/2008: Anesthesia Coding Policy hyperlink added
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
9/29/2009: Code reference section updated. New ICD-9 diagnosis code 569.71 added to covered table. |
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