| LCD | Title |
Effective Date |
| L36095 |
MolDX: MGMT Promoter Methylation Analysis-Noridian Healthcare Solutions, LLC |
|
| L36132 |
MolDX: Genetic Testing for Hypercoagulability / Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR)-Noridian Healthcare Solutions, LLC |
|
| L36140 |
Bioimpedance Spectroscopy (BIS) Devices for the Detection and Management of Lymphedema-National Government Services, Inc. |
|
| L36146 |
MolDX: HLA-B*15:02 Genetic Testing-Noridian Healthcare Solutions, LLC |
|
| L36176 |
MolDX: NSCLC, Comprehensive Genomic Profile Testing-Noridian Healthcare Solutions, LLC |
|
| L36181 |
MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease-Noridian Healthcare Solutions, LLC |
|
| L36189 |
MolDX: MGMT Promoter Methylation Analysis-Noridian Healthcare Solutions, LLC |
|
| L36195 |
MolDX: NSCLC, Comprehensive Genomic Profile Testing-Noridian Healthcare Solutions, LLC |
|
| L36264 |
Lower Limb Prostheses-NHIC, Corp. |
|
| L36295 |
Surgical Dressings-NHIC, Corp. |
|
| L36317 |
MolDX: Biomarkers in Cardiovascular Risk Assessment-Noridian Healthcare Solutions, LLC |
|
| L36319 |
MolDX: Breast Cancer Assay: Prosigna -Noridian Healthcare Solutions, LLC |
|
| L36359 |
MolDX: Biomarkers in Cardiovascular Risk Assessment-Noridian Healthcare Solutions, LLC |
|
| L36383 |
MolDX: Breast Cancer Assay: Prosigna -Noridian Healthcare Solutions, LLC |
|
| L36414 |
Removal of Benign Skin Lesions-Novitas Solutions, Inc. |
|
| L36558 |
Intensity Modulated Radiation Therapy (IMRT)-Noridian Healthcare Solutions, LLC |
|
| L36580 |
Intensity Modulated Radiation Therapy (IMRT)-Noridian Healthcare Solutions, LLC |
|
| L36660 |
Molecular Pathology Procedures-National Government Services, Inc. |
|
| L36676 |
Botulinum Toxin Types A and B Policy-Noridian Healthcare Solutions, LLC |
|
| L36677 |
Bladder Tumor Markers-Noridian Healthcare Solutions, LLC |
|
| L36679 |
Bladder Tumor Markers-Noridian Healthcare Solutions, LLC |
|
| L36681 |
Vitamin D Assay Testing-Noridian Healthcare Solutions, LLC |
|
| L36683 |
Botulinum Toxin Types A and B-Noridian Healthcare Solutions, LLC |
|
| L36685 |
Hyperbaric Oxygen (HBO) Therapy -Noridian Healthcare Solutions, LLC |
|
| L36687 |
Intraoperative Neurophysiological Testing-Noridian Healthcare Solutions, LLC |
|
| L36691 |
Vitamin D Assay Testing-Noridian Healthcare Solutions, LLC |
|
| L36695 |
Hyperbaric Oxygen (HBO) Therapy -Noridian Healthcare Solutions, LLC |
|
| L36697 |
Intraoperative Neurophysiological Testing-Noridian Healthcare Solutions, LLC |
|
| L36699 |
Serum Magnesium-Noridian Healthcare Solutions, LLC |
|
| L36701 |
Serum Magnesium-Noridian Healthcare Solutions, LLC |
|
| L36703 |
MolDX- CDD: ProMark Risk Score-Noridian Healthcare Solutions, LLC |
|
| L36705 |
MolDX-CDD: ProMark Risk Score-Noridian Healthcare Solutions, LLC |
|
| L36710 |
Intensity Modulated Radiation Therapy (IMRT)-Novitas Solutions, Inc. |
|
| L36712 |
Corus® CAD Test-Novitas Solutions, Inc. |
|
| L36714 |
BRCA1 and BRCA2 Genetic Testing-Novitas Solutions, Inc. |
|
| L36720 |
Non-Invasive Cerebrovascular Arterial Studies-Novitas Solutions, Inc. |
|
| L36721 |
Non-Invasive Peripheral Venous Studies-Novitas Solutions, Inc. |
|
| L36726 |
Biomarkers Overview-Novitas Solutions, Inc. |
|
| L36739 |
Biomarkers for Oncology-Novitas Solutions, Inc. |
|
| L36753 |
Pulmonary Stress Testing-Palmetto GBA |
|
| L36757 |
Upper Gastrointestinal Endoscopy and Visualization-Palmetto GBA |
|
| L36762 |
4Kscore Assay-Palmetto GBA |
|
| L36784 |
MolDX: Breast Cancer Index℠ Genetic Assay-Wisconsin Physicians Service Insurance Corporation |
|
| L36786 |
MolDX-CDD: Prolaris™ Prostate Cancer Genomic Assay -Wisconsin Physicians Service Insurance Corporation |
|
| L36788 |
MoLDX-CDD: Genomic Health™ Oncotype DX® Prostate Cancer Assay-Wisconsin Physicians Service Insurance Corporation |
|
| L36790 |
MolDX-CDD: Decipher® Prostate Cancer Classifier Assay-Wisconsin Physicians Service Insurance Corporation |
|
| L36792 |
MolDX: Genetic Testing for Lynch Syndrome-Wisconsin Physicians Service Insurance Corporation |
|
| L36794 |
MolDX: Molecular RBC Phenotyping-Wisconsin Physicians Service Insurance Corporation |
|
| L36796 |
MolDX: NRAS Genetic Testing-Wisconsin Physicians Service Insurance Corporation |
|
| L36798 |
MolDX: GeneSight® Assay for Refractory Depression-Wisconsin Physicians Service Insurance Corporation |
|
| L36800 |
MolDX: HLA-B*15:02 Genetic Testing-Wisconsin Physicians Service Insurance Corporation |
|
| L36802 |
MolDX-CDD: NSCLC, Comprehensive Genomic Profile Testing-Wisconsin Physicians Service Insurance Corporation |
|
| L36804 |
Special Histochemical Stains and Immunohistochemical Stains-Wisconsin Physicians Service Insurance Corporation |
|
| L36806 |
MolDX: Molecular Diagnostic Tests (MDT)-Wisconsin Physicians Service Insurance Corporation |
|
| L36810 |
MolDX: Breast Cancer Assay: Prosigna-Wisconsin Physicians Service Insurance Corporation |
|
| L36812 |
MolDX: BRCA1 and BRCA2 Genetic Testing-Wisconsin Physicians Service Insurance Corporation |
|
| L36814 |
MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease-Wisconsin Physicians Service Insurance Corporation |
|
| L36826 |
MolDX: APC and MUTYH Gene Testing -Palmetto GBA |
|
| L36829 |
MolDX: HLA-DQB1*06:02 Testing for Narcolepsy-Palmetto GBA |
|
| L36830 |
Visual Electrophysiology Testing -National Government Services, Inc. |
|
| L36836 |
Chest X-Ray Policy-Noridian Healthcare Solutions, LLC |
|
| L36838 |
Polysomnography and Other Sleep Studies-Wisconsin Physicians Service Insurance Corporation |
|
| L36840 |
Chest X-Ray Policy-Noridian Healthcare Solutions, LLC |
|
| L36845 |
Measurement of Salivary Hormones-Noridian Healthcare Solutions, LLC |
|
| L36847 |
Polysomnography and Other Sleep Studies-Noridian Healthcare Solutions, LLC |
|
| L36848 |
Diagnostic and Therapeutic Colonoscopy -Noridian Healthcare Solutions, LLC |
|
| L36849 |
Peripheral Nerve Blocks-National Government Services, Inc. |
|
| L36853 |
MolDX-CDD: Percepta© Bronchial Genomic Classifier-Palmetto GBA |
|
| L36855 |
Trigger Point Injections-Noridian Healthcare Solutions, LLC |
|
| L36856 |
Measurement of Salivary Hormones-Noridian Healthcare Solutions, LLC |
|
| L36858 |
Trigger Point Injections-Noridian Healthcare Solutions, LLC |
|
| L36860 |
Polysomnography and Other Sleep Studies-Noridian Healthcare Solutions, LLC |
|
| L36863 |
GlycoMark Testing for Glycemic Control-Noridian Healthcare Solutions, LLC |
|
| L36865 |
GlycoMark Testing for Glycemic Control-Noridian Healthcare Solutions, LLC |
|
| L36867 |
Diagnostic and Therapeutic Colonoscopy -Noridian Healthcare Solutions, LLC |
|
| L36869 |
Vertebroplasty, Vertebral Augmentation (Kyphoplasty) Percutaneous-Novitas Solutions, Inc. |
|
| L36870 |
Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma-Noridian Healthcare Solutions, LLC |
|
| L36874 |
Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma-Noridian Healthcare Solutions, LLC |
|
| L36878 |
Surgery: Spinal Cord Stimulators for Chronic Pain-Cahaba Government Benefit Administrators®, LLC |
|
| L36881 |
MolDX: APC and MUTYH Gene Testing -Noridian Healthcare Solutions, LLC |
|
| L36883 |
MolDX: APC and MUTYH Gene Testing -Noridian Healthcare Solutions, LLC |
|
| L36885 |
MolDX-CDD: Percepta© Bronchial Genomic Classifier-Noridian Healthcare Solutions, LLC |
|
| L36887 |
Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography-Noridian Healthcare Solutions, LLC |
|
| L36888 |
Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography-Noridian Healthcare Solutions, LLC |
|
| L36890 |
MolDX-CDD: Percepta© Bronchial Genomic Classifier-Noridian Healthcare Solutions, LLC |
|
| L36901 |
Polysomnography and Other Sleep Studies-CGS Administrators, LLC |
|
| L36903 |
Cognitive Rehabilitation-National Government Services, Inc. |
|
| L36905 |
GlycoMark Testing for Glycemic Control-CGS Administrators, LLC |
|
| L36907 |
MolDX-CDD: Percepta© Bronchial Genomic Classifier-CGS Administrators, LLC |
|
| L36909 |
MolDX: APC and MUTYH Gene Testing -CGS Administrators, LLC |
|
| L36911 |
MolDX - CDD: Oncotype DX® Breast Cancer for DCIS (Genomic Health ™)-Palmetto GBA |
|
| L36919 |
Epidural Injections for Pain Management -Novitas Solutions, Inc. |
|
| L36925 |
Genomic Sequence Analysis Panels in the Treatment of Acute Myelogenous Leukemia (AML)-National Government Services, Inc. |
|
| L36927 |
Removal of Benign and Malignant Skin Lesions-Palmetto GBA |
|
| L36928 |
Chemodenervation-Palmetto GBA |
|
| L36929 |
Infliximab (Remicade®)-Palmetto GBA |
|
| L36930 |
Blepharoplasty, Eyelid Surgery, and Brow Lift-Palmetto GBA |
|
| L36931 |
Implantable Infusion Pump-Palmetto GBA |
|
| L36934 |
Vestibular Function Testing-Palmetto GBA |
|
| L36936 |
Laparoscopic Sleeve Gastrectomy for Severe Obesity-Palmetto GBA |
|
| L36938 |
Retroperitoneal Ultrasound-Palmetto GBA |
|
| L36939 |
Outpatient Occupational Therapy-Palmetto GBA |
|
| L36940 |
MolDX - CDD: Oncotype DX® Breast Cancer for DCIS (Genomic Health ™)-Noridian Healthcare Solutions, LLC |
|
| L36943 |
Special Electroencephalography-Palmetto GBA |
|
| L36944 |
Surgery: Bioimpedance Spectroscopy (BIS) Devices for the Detection and Management of Lymphedema-Cahaba Government Benefit Administrators®, LLC |
|
| L36946 |
MolDX - CDD: Oncotype DX® Breast Cancer for DCIS (Genomic Health ™)-Noridian Healthcare Solutions, LLC |
|
| L36950 |
MolDX - CDD: Oncotype DX® Breast Cancer for DCIS (Genomic Health ™)-CGS Administrators, LLC |
|
| L36952 |
MolDX: HLA-DQB1*06:02 Testing for Narcolepsy-CGS Administrators, LLC |
|
| L36953 |
Noncovered Services other than CPT® Category III Noncovered Services-Palmetto GBA |
|
| L36961 |
Vascular Endothelial Growth Factor Inhibitors for the Treatment of Ophthalmological Diseases -First Coast Service Options, Inc. |
|
| L36965 |
Noncovered Services-First Coast Service Options, Inc. |
|
| L36972 |
Circulating Tumor Cell Marker Assays-CGS Administrators, LLC |
|
| L36974 |
Bladder Tumor Markers-CGS Administrators, LLC |
|
| L36978 |
4Kscore Assay-CGS Administrators, LLC |
|
| L36980 |
Nerve Conduction Studies and Electromyography-CGS Administrators, LLC |
|
| L37000 |
MolDX: MGMT Promoter Methylation Analysis-Wisconsin Physicians Service Insurance Corporation |
|
| L37002 |
MolDX: HLA-DQB1*06:02 Testing for Narcolepsy-Wisconsin Physicians Service Insurance Corporation |
|
| L37004 |
MolDX-CDD: ConfirmMDx Epigenetic Molecular Assay-Wisconsin Physicians Service Insurance Corporation |
|
| L37006 |
Infectious Disease Molecular Diagnostic Testing-Wisconsin Physicians Service Insurance Corporation |
|
| L37008 |
MolDX: Chromosome 1p/19q Deletion Analysis-Wisconsin Physicians Service Insurance Corporation |
|
| L37010 |
MolDX-CDD: ProMark Risk Score-Wisconsin Physicians Service Insurance Corporation |
|
| L37012 |
MolDX: 4Kscore Assay-Wisconsin Physicians Service Insurance Corporation |
|
| L37014 |
Visual Electrophysiology Testing-Wisconsin Physicians Service Insurance Corporation |
|
| L37018 |
Plastic Surgery-Noridian Healthcare Solutions, LLC |
|
| L37019 |
Plastic Surgery-Noridian Healthcare Solutions, LLC |
|
| L37021 |
Coenzyme Q10 (CoQ10)-Palmetto GBA |
|
| L37023 |
MolDX: VectraDA, a Multibiomarker Disease Activity Test for Rheumatoid Arthritis (RA)-Palmetto GBA |
|
| L37025 |
Cataract Surgery in Adults-Noridian Healthcare Solutions, LLC |
|
| L37026 |
Cataract Surgery in Adults-Noridian Healthcare Solutions, LLC |
|
| L37030 |
MolDX: Xpresys Lung -Palmetto GBA |
|
| L37032 |
MolDX: DecisionDx-UM (Uveal Melanoma)-Palmetto GBA |
|
| L37034 |
MolDX: Vita Risk™ Pharmacogenetic Test for Dry Age-related Macular Degeneration (AMD)-Palmetto GBA |
|
| L37038 |
MolDX: Comprehensive Genomic Profiling to Guide Treatment in Patients with Metastatic Colorectal Cancer-Palmetto GBA |
|
| L37040 |
MolDX: Comprehensive Genomic Profiling to Guide Treatment in Patients with Metastatic Melanoma-Palmetto GBA |
|
| L37042 |
MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease-Palmetto GBA |
|
| L37044 |
MolDX: Comprehensive Genomic Profiling to Guide Treatment in Patients with Advanced Primary Peritoneal, Fallopian Tube and Ovarian Cancer-Palmetto GBA |
|
| L37053 |
MolDX: Xpresys Lung -Noridian Healthcare Solutions, LLC |
|
| L37059 |
MolDX: Vita Risk™ Pharmacogenetic Test for Dry Age-related Macular Degeneration (AMD)-Noridian Healthcare Solutions, LLC |
|
| L37061 |
MolDX: Xpresys Lung -Noridian Healthcare Solutions, LLC |
|
| L37063 |
MolDX: Vita Risk™ Pharmacogenetic Test for Dry Age-related Macular Degeneration (AMD)-Noridian Healthcare Solutions, LLC |
|
| L37065 |
Coenzyme Q10 (CoQ10)-Noridian Healthcare Solutions, LLC |
|
| L37067 |
Coenzyme Q10 (CoQ10)-Noridian Healthcare Solutions, LLC |
|
| L37069 |
MolDX: DecisionDx-UM (Uveal Melanoma)-Noridian Healthcare Solutions, LLC |
|
| L37071 |
MolDX: DecisionDx-UM (Uveal Melanoma)-Noridian Healthcare Solutions, LLC |
|
| L37077 |
Genomic Sequence Analysis Panels in the Treatment of Myelodysplastic Syndromes (MDS)-National Government Services, Inc. |
|
| L37079 |
MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease-Noridian Healthcare Solutions, LLC |
|
| L37081 |
MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease-Noridian Healthcare Solutions, LLC |
|
| L37085 |
Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder-Noridian Healthcare Solutions, LLC |
|
| L37087 |
Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder-Noridian Healthcare Solutions, LLC |
|
| L37089 |
MolDX: VectraDA, a Multibiomarker Disease Activity Test for Rheumatoid Arthritis (RA)-Noridian Healthcare Solutions, LLC |
|
| L37091 |
MolDX: VectraDA, a Multibiomarker Disease Activity Test for Rheumatoid Arthritis (RA)-Noridian Healthcare Solutions, LLC |
|
| L37100 |
MolDX: Comprehensive Genomic Profiling to Guide Treatment in Patients with Advanced Primary Peritoneal, Fallopian Tube and Ovarian Cancer-Noridian Healthcare Solutions, LLC |
|
| L37102 |
MolDX: Comprehensive Genomic Profiling to Guide Treatment in Patients with Advanced Primary Peritoneal, Fallopian Tube and Ovarian Cancer-Noridian Healthcare Solutions, LLC |
|
| L37104 |
MolDX: Comprehensive Genomic Profiling to Guide Treatment in Patients with Metastatic Colorectal Cancer-Noridian Healthcare Solutions, LLC |
|
| L37106 |
MolDX: Comprehensive Genomic Profiling to Guide Treatment in Patients with Metastatic Colorectal Cancer-Noridian Healthcare Solutions, LLC |
|
| L37108 |
MolDX: Comprehensive Genomic Profiling to Guide Treatment in Patients with Metastatic Melanoma-Noridian Healthcare Solutions, LLC |
|
| L37110 |
MolDX: Comprehensive Genomic Profiling to Guide Treatment in Patients with Metastatic Melanoma-Noridian Healthcare Solutions, LLC |
|
| L37113 |
Visual Electrophysiology Testing -Noridian Healthcare Solutions, LLC |
|
| L37115 |
Visual Electrophysiology Testing -Noridian Healthcare Solutions, LLC |
|
| L37119 |
4Kscore Assay-Noridian Healthcare Solutions, LLC |
|
| L37121 |
4Kscore Assay-Noridian Healthcare Solutions, LLC |
|
| L37123 |
Endoscopic Treatment of GERD-National Government Services, Inc. |
|
| L37125 |
Coenzyme Q10 (CoQ10)-CGS Administrators, LLC |
|
| L37127 |
MolDX: Comprehensive Genomic Profiling to Guide Treatment in Patients with Advanced Primary Peritoneal, Fallopian Tube and Ovarian Cancer-CGS Administrators, LLC |
|
| L37129 |
MolDX: DecisionDx-UM (Uveal Melanoma)-CGS Administrators, LLC |
|
| L37131 |
MolDX: VectraDA, a Multibiomarker Disease Activity Test for Rheumatoid Arthritis (RA)-CGS Administrators, LLC |
|
| L37133 |
MolDX: Xpresys Lung -CGS Administrators, LLC |
|
| L37135 |
MolDX: Comprehensive Genomic Profiling to Guide Treatment in Patients with Metastatic Colorectal Cancer-CGS Administrators, LLC |
|
| L37137 |
MolDX: Comprehensive Genomic Profiling to Guide Treatment in Patients with Metastatic Melanoma-CGS Administrators, LLC |
|
| L37139 |
MolDX: Vita Risk™ Pharmacogenetic Test for Dry Age-related Macular Degeneration (AMD)-CGS Administrators, LLC |
|
| L37141 |
MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease-CGS Administrators, LLC |
|
| L37143 |
Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder-CGS Administrators, LLC |
|
| L37144 |
Retroperitoneal Ultrasound-Palmetto GBA |
|
| L37145 |
Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)-Palmetto GBA |
|
| L37146 |
Magnetic Resonance Angiography-Palmetto GBA |
|
| L37147 |
Allergy Skin Testing-Palmetto GBA |
|
| L37148 |
Transesophageal Echocardiography (TEE)-Palmetto GBA |
|
| L37149 |
Wireless Capsule Endoscopy-Palmetto GBA |
|
| L37150 |
Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy-Palmetto GBA |
|
| L37151 |
Virtual Colonoscopy (CT Colonography)-Palmetto GBA |
|
| L37152 |
CT of the Head-Palmetto GBA |
|
| L37155 |
Somatosensory Testing-Palmetto GBA |
|
| L37156 |
Octreotide Acetate for Injectable Suspension (Sandostatin LAR depot)-Palmetto GBA |
|
| L37157 |
Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder -Novitas Solutions, Inc. |
|
| L37158 |
Scanning Computerized Ophthalmic Diagnostic Imaging-Novitas Solutions, Inc. |
|
| L37159 |
Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)-First Coast Service Options, Inc. |
|
| L37162 |
Wound Care-Novitas Solutions, Inc. |
|
| L37165 |
Wound Care-First Coast Service Options, Inc. |
|
| L37169 |
Treatment of Varicose Veins of the Lower Extremities-Novitas Solutions, Inc. |
|
| L37174 |
Noncovered Services-First Coast Service Options, Inc. |
|
| L37175 |
White Cell Colony Stimulating Factors-Palmetto GBA |
|
| L37192 |
Coenzyme Q10 Testing-Wisconsin Physicians Service Insurance Corporation |
|
| L37194 |
MolDX-CDD: Percepta© Bronchial Genomic Classifier-Wisconsin Physicians Service Insurance Corporation |
|
| L37198 |
MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health™)-Wisconsin Physicians Service Insurance Corporation |
|
| L37200 |
MolDX: VectraDA, a Multibiomarker Disease Activity Test for Rheumatoid Arthritis (RA)-Wisconsin Physicians Service Insurance Corporation |
|
| L37202 |
MolDX: Comprehensive Genomic Profiling to Guide Treatment in Patients with Advanced Primary Peritoneal, Fallopian Tube and Ovarian Cancer-Wisconsin Physicians Service Insurance Corporation |
|
| L37204 |
Chemotherapy Drugs and their Adjuncts-Wisconsin Physicians Service Insurance Corporation |
|
| L37209 |
MolDX: Decision Dx-UM (Uveal Melanoma)-Wisconsin Physicians Service Insurance Corporation |
|
| L37215 |
MolDX: Xpresys Lung-Wisconsin Physicians Service Insurance Corporation |
|
| L37217 |
MolDX: Vita Risk™ Pharmacogenetic Test for Dry Age-related Macular Degeneration (AMD)-Wisconsin Physicians Service Insurance Corporation |
|
| L37219 |
MolDX: Comprehensive Genomic Profiling to Guide Treatment in Patients with Metastatic Melanoma-Wisconsin Physicians Service Insurance Corporation |
|
| L37221 |
MolDX: Comprehensive Genomic Profiling to Guide Treatment in Patients with Metastatic Colorectal Cancer-Wisconsin Physicians Service Insurance Corporation |
|
| L37223 |
MolDX: APC and MUTYH Gene Testing-Wisconsin Physicians Service Insurance Corporation |
|
| L37225 |
MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease-Wisconsin Physicians Service Insurance Corporation |
|
| L37227 |
Wound Care-Wisconsin Physicians Service Insurance Corporation |
|
| L37240 |
Chiropractic Services-Noridian Healthcare Solutions, LLC |
|
| L37243 |
Micro-Invasive Glaucoma Surgery (MIGS) -National Government Services, Inc. |
|
| L37245 |
Varicose Veins of the Lower Extremity, Treatment of-National Government Services, Inc. |
|
| L37246 |
Noninvasive Peripheral Venous Studies-Noridian Healthcare Solutions, LLC |
|
| L37247 |
Chiropractic Services-Noridian Healthcare Solutions, LLC |
|
| L37249 |
MolDX: APC and MUTYH Gene Testing -CGS Administrators, LLC |
|
| L37250 |
MolDX-CDD: Percepta© Bronchial Genomic Classifier-CGS Administrators, LLC |
|
| L37253 |
Chiropractic Services-CGS Administrators, LLC |
|
| L37257 |
MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels-Palmetto GBA |
|
| L37259 |
MolDX: Prometheus IBD sgi Diagnostic Policy-Palmetto GBA |
|
| L37261 |
MolDX: Oncotype DX® Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer-Palmetto GBA |
|
| L37263 |
MolDX: EndoPredict Breast Cancer Gene Expression Test-Palmetto GBA |
|
| L37265 |
MolDX: AlloSure® Donor-Derived Cell-Free DNA Test-Palmetto GBA |
|
| L37268 |
Electrocardiograms-Noridian Healthcare Solutions, LLC |
|
| L37270 |
Monitored Anesthesia Care (MAC)-Noridian Healthcare Solutions, LLC |
|
| L37271 |
Monitored Anesthesia Care (MAC)-Noridian Healthcare Solutions, LLC |
|
| L37279 |
Lumbar MRI-Noridian Healthcare Solutions, LLC |
|
| L37280 |
Lumbar MRI-Noridian Healthcare Solutions, LLC |
|
| L37282 |
Electrocardiograms-Noridian Healthcare Solutions, LLC |
|
| L37284 |
MRI and CT Scans of the Head and Neck-Noridian Healthcare Solutions, LLC |
|
| L37285 |
Pulmonary Function Testing-Noridian Healthcare Solutions, LLC |
|
| L37286 |
Peripheral Nerve Stimulation-Noridian Healthcare Solutions, LLC |
|
| L37287 |
Respiratory Care (Respiratory Therapy )-Noridian Healthcare Solutions, LLC |
|
| L37288 |
Pulmonary Function Testing-Noridian Healthcare Solutions, LLC |
|
| L37290 |
Noninvasive Peripheral Venous Studies-Noridian Healthcare Solutions, LLC |
|
| L37292 |
Respiratory Care (Respiratory Therapy )-Noridian Healthcare Solutions, LLC |
|
| L37294 |
MolDX: EndoPredict® Breast Cancer Gene Expression Test-Noridian Healthcare Solutions, LLC |
|
| L37298 |
MolDX: Prometheus IBD sgi Diagnostic Policy-Noridian Healthcare Solutions, LLC |
|
| L37300 |
MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels-Noridian Healthcare Solutions, LLC |
|
| L37302 |
MolDX: AlloSure® Donor-Derived Cell-Free DNA Test-Noridian Healthcare Solutions, LLC |
|
| L37304 |
MolDX: Oncotype DX® Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer-Noridian Healthcare Solutions, LLC |
|
| L37306 |
Noninvasive Physiologic Studies of Upper or Lower Extremity Arteries-Noridian Healthcare Solutions, LLC |
|
| L37308 |
Duplex Scan Of Lower Extremity Arteries-Noridian Healthcare Solutions, LLC |
|
| L37310 |
MolDX: EndoPredict® Breast Cancer Gene Expression Test-Noridian Healthcare Solutions, LLC |
|
| L37312 |
MolDX: Prometheus IBD sgi Diagnostic Policy-Noridian Healthcare Solutions, LLC |
|
| L37314 |
MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels-Noridian Healthcare Solutions, LLC |
|
| L37316 |
Noninvasive Extracranial Arterial Studies-Noridian Healthcare Solutions, LLC |
|
| L37318 |
Transcranial Doppler Studies-Noridian Healthcare Solutions, LLC |
|
| L37320 |
MolDX: Oncotype DX® Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer-Noridian Healthcare Solutions, LLC |
|
| L37324 |
Allergy Testing-Noridian Healthcare Solutions, LLC |
|
| L37327 |
Medicine: Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder-Cahaba Government Benefit Administrators®, LLC |
|
| L37329 |
MolDX: Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification Tests (NAATs) -Palmetto GBA |
|
| L37331 |
Medicine: Visual Electrophysiology Testing-Cahaba Government Benefit Administrators®, LLC |
|
| L37333 |
Medicine: Somatosensory Testing-Cahaba Government Benefit Administrators®, LLC |
|
| L37335 |
Noninvasive Physiologic Studies of Upper or Lower Extremity Arteries-Noridian Healthcare Solutions, LLC |
|
| L37337 |
MolDX: Guardant360® Plasma-Based Comprehensive Genomic Profiling in Non-Small Cell Lung Cancer (NSCLC)-Palmetto GBA |
|
| L37339 |
Duplex Scan Of Lower Extremity Arteries-Noridian Healthcare Solutions, LLC |
|
| L37341 |
Allergy Testing-Noridian Healthcare Solutions, LLC |
|
| L37343 |
Noninvasive Extracranial Arterial Studies-Noridian Healthcare Solutions, LLC |
|
| L37345 |
Transcranial Doppler Studies-Noridian Healthcare Solutions, LLC |
|
| L37347 |
MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels-CGS Administrators, LLC |
|
| L37349 |
MolDX: Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification Tests (NAATs) -Noridian Healthcare Solutions, LLC |
|
| L37351 |
MolDX: Prometheus IBD sgi Diagnostic Policy-CGS Administrators, LLC |
|
| L37353 |
MolDX: Oncotype DX® Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer-CGS Administrators, LLC |
|
| L37355 |
MolDX: EndoPredict Breast Cancer Gene Expression Test-CGS Administrators, LLC |
|
| L37357 |
MolDX: AlloSure® Donor-Derived Cell-Free DNA Test-Noridian Healthcare Solutions, LLC |
|
| L37359 |
Peripheral Nerve Stimulation-Noridian Healthcare Solutions, LLC |
|
| L37361 |
MolDX: AlloSure® Donor-Derived Cell-Free DNA Test-CGS Administrators, LLC |
|
| L37363 |
MolDX: Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification Tests (NAATs) -CGS Administrators, LLC |
|
| L37365 |
MolDX: Guardant360® Plasma-Based Comprehensive Genomic Profiling in Non-Small Cell Lung Cancer (NSCLC)-CGS Administrators, LLC |
|
| L37367 |
MolDX: Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification Tests (NAATs) -Noridian Healthcare Solutions, LLC |
|
| L37369 |
Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography-Novitas Solutions, Inc. |
|
| L37370 |
Electroretinography (ERG)-Novitas Solutions, Inc. |
|
| L37372 |
MRI and CT Scans of the Head and Neck-Noridian Healthcare Solutions, LLC |
|
| L37374 |
Reflectance Confocal Microscopy-Novitas Solutions, Inc. |
|
| L37376 |
Cosmetic and Reconstructive Surgery-Palmetto GBA |
|
| L37377 |
Cardiac Computed Tomography & Angiography (CCTA)-Palmetto GBA |
|
| L37378 |
Echocardiography -Palmetto GBA |
|
| L37380 |
Non-Covered Category III CPT Codes-Palmetto GBA |
|
| L37386 |
Chiropractic Services-Palmetto GBA |
|
| L37388 |
Vertebroplasty/Kyphoplasty-Palmetto GBA |
|
| L37397 |
Electroretinography (ERG)-First Coast Service Options, Inc. |
|
| L37403 |
Lower Extremity Revascularization -First Coast Service Options, Inc. |
|
| L37420 |
Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Essential Tremor-National Government Services, Inc. |
|
| L37474 |
Frequency of Hemodialysis-National Government Services, Inc. |
|
| L37482 |
MolDX: GeneSight® Assay for Refractory Depression-Palmetto GBA |
|
| L37483 |
MolDX: Circulating Tumor Cell Marker Assays-Palmetto GBA |
|
| L37484 |
Prostate Rectal Spacers-National Government Services, Inc. |
|
| L37486 |
MolDX: Pigmented Lesion Assay (PLA) and PLA Score-Palmetto GBA |
|
| L37490 |
MolDX: Genetic Testing for Lynch Syndrome-Palmetto GBA |
|
| L37500 |
Frequency of Hemodialysis-Palmetto GBA |
|
| L37501 |
Frequency of Hemodialysis-Noridian Healthcare Solutions, LLC |
|
| L37503 |
Frequency of Hemodialysis-Noridian Healthcare Solutions, LLC |
|
| L37530 |
Micro-Invasive Glaucoma Surgery (MIGS) -Palmetto GBA |
|
| L37532 |
MolDX: Pigmented Lesion Assay (PLA) and PLA Score-CGS Administrators, LLC |
|
| L37534 |
Vitamin D Assay Testing-National Government Services, Inc. |
|
| L37536 |
Frequency of Hemodialysis-Wisconsin Physicians Service Insurance Corporation |
|
| L37538 |
MolDX: Prometheus IBD sgi Diagnostic Policy-Wisconsin Physicians Service Insurance Corporation |
|
| L37546 |
Chest X-Ray Policy-Noridian Healthcare Solutions, LLC |
|
| L37548 |
Chest X-Ray-Noridian Healthcare Solutions, LLC |
|
| L37560 |
Cystatin C Measurement-First Coast Service Options, Inc. |
|
| L37562 |
Frequency of Hemodialysis-Novitas Solutions, Inc. |
|
| L37563 |
Frequency of Hemodialysis-First Coast Service Options, Inc. |
|
| L32553 |
Allergy Immunotherapy-CGS Administrators, LLC |
10/01/2015 |
| L33252 |
Psychiatric Diagnostic Evaluation and Psychotherapy Services-First Coast Service Options, Inc. |
10/01/2015 |
| L33256 |
3D Interpretation and Reporting of Imaging Studies-First Coast Service Options, Inc. |
10/01/2015 |
| L33257 |
Abatacept-First Coast Service Options, Inc. |
10/01/2015 |
| L33261 |
Allergy Testing-First Coast Service Options, Inc. |
10/01/2015 |
| L33263 |
Anorectal Manometry and EMG of the Urinary and Anal Sphincters-First Coast Service Options, Inc. |
10/01/2015 |
| L33266 |
Azacitidine (Vidaza®)-First Coast Service Options, Inc. |
10/01/2015 |
| L33267 |
B-Type Natriuretic Peptide (BNP)-First Coast Service Options, Inc. |
10/01/2015 |
| L33268 |
Bendamustine hydrochloride (Treanda®, Bendeka™)-First Coast Service Options, Inc. |
10/01/2015 |
| L33270 |
Bisphosphonates (Intravenous [IV]) and Monoclonal Antibodies in the Treatment of Osteoporosis and Their Other Indications-First Coast Service Options, Inc. |
10/01/2015 |
| L33271 |
Biventricular Pacing/ Cardiac Resynchronization Therapy-First Coast Service Options, Inc. |
10/01/2015 |
| L33272 |
Bone and/or Joint Imaging-First Coast Service Options, Inc. |
10/01/2015 |
| L33273 |
Bortezomib (Velcade®)-First Coast Service Options, Inc. |
10/01/2015 |
| L33274 |
Botulinum Toxins-First Coast Service Options, Inc. |
10/01/2015 |
| L33275 |
Carboplatin (Paraplatin®, Paraplatin-AQ®)-First Coast Service Options, Inc. |
10/01/2015 |
| L33278 |
Cetuximab (Erbitux®)-First Coast Service Options, Inc. |
10/01/2015 |
| L33279 |
Circulating Tumor Cell Testing-First Coast Service Options, Inc. |
10/01/2015 |
| L33280 |
Collagenase clostridium histolyticum (Xiaflex ®)-First Coast Service Options, Inc. |
10/01/2015 |
| L33282 |
Computed Tomographic Angiography of the Chest, Heart and Coronary Arteries-First Coast Service Options, Inc. |
10/01/2015 |
| L33283 |
Computed Tomographic Colonography-First Coast Service Options, Inc. |
10/01/2015 |
| L33284 |
Computed Tomography of the Abdomen and Pelvis-First Coast Service Options, Inc. |
10/01/2015 |
| L33285 |
Computed Tomography of the Thorax-First Coast Service Options, Inc. |
10/01/2015 |
| L33296 |
Noncovered Procedures - Endoscopic Treatment of Gastroesophageal Reflux Disease (GERD)-First Coast Service Options, Inc. |
10/01/2015 |
| L33312 |
Wheelchair Seating-Noridian Administrative Services |
10/01/2015 |
| L33316 |
Dialysis (AV fistula and graft) Vascular Access Maintenance-First Coast Service Options, Inc. |
10/01/2015 |
| L33317 |
External Breast Prostheses-Noridian Administrative Services |
10/01/2015 |
| L33318 |
Knee Orthoses-Noridian Administrative Services |
10/01/2015 |
| L33369 |
Therapeutic Shoes for Persons with Diabetes-Noridian Administrative Services |
10/01/2015 |
| L33370 |
Nebulizers-Noridian Administrative Services |
10/01/2015 |
| L33377 |
Implantable Miniature Telescope (IMT)-First Coast Service Options, Inc. |
10/01/2015 |
| L33379 |
Intraoperative Neurophysiology Monitoring-First Coast Service Options, Inc. |
10/01/2015 |
| L33380 |
Long-Term Wearable Electrocardiographic Monitoring (WEM)-First Coast Service Options, Inc. |
10/01/2015 |
| L33381 |
Low Density Lipoprotein (LDL) Apheresis-First Coast Service Options, Inc. |
10/01/2015 |
| L33382 |
Lumbar Spinal Fusion for Instability and Degenerative Disc Conditions-First Coast Service Options, Inc. |
10/01/2015 |
| L33383 |
Non- Emergency Ground Ambulance Services-First Coast Service Options, Inc. |
10/01/2015 |
| L33392 |
Category III CPT® Codes-National Government Services, Inc. |
10/01/2015 |
| L33393 |
Hospice - Determining Terminal Status-National Government Services, Inc. |
10/01/2015 |
| L33394 |
Drugs and Biologicals, Coverage of, for Label and Off-Label Uses-National Government Services, Inc. |
10/01/2015 |
| L33396 |
Posterior Tibial Nerve Stimulation for Voiding Dysfunction-National Government Services, Inc. |
10/01/2015 |
| L33398 |
Transcranial Magnetic Stimulation-National Government Services, Inc. |
10/01/2015 |
| L33399 |
EEG – 24 Hour Monitoring-National Government Services, Inc. |
10/01/2015 |
| L33405 |
Polysomnography and Sleep Testing-First Coast Service Options, Inc. |
10/01/2015 |
| L33406 |
Posterior Tibial Nerve Stimulation (PTNS)-First Coast Service Options, Inc. |
10/01/2015 |
| L33407 |
Ranibizumab (Lucentis ®)-First Coast Service Options, Inc. |
10/01/2015 |
| L33410 |
Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)-First Coast Service Options, Inc. |
10/01/2015 |
| L33411 |
Surgical Management of Morbid Obesity-First Coast Service Options, Inc. |
10/01/2015 |
| L33412 |
Testosterone pellets (Testopel®)-First Coast Service Options, Inc. |
10/01/2015 |
| L33413 |
Therapy and Rehabilitation Services-First Coast Service Options, Inc. |
10/01/2015 |
| L33414 |
Topical Photosensitizers used with PDT for Actinic Keratoses and Certain Skin Cancers-First Coast Service Options, Inc. |
10/01/2015 |
| L33416 |
3D Interpretation and Reporting of Imaging Studies-Palmetto GBA |
10/01/2015 |
| L33417 |
Allergy Skin Testing-Palmetto GBA |
10/01/2015 |
| L33418 |
Assays for Vitamins and Metabolic Function-Palmetto GBA |
10/01/2015 |
| L33420 |
Bladder/Urothelial Tumor Markers-Palmetto GBA |
10/01/2015 |
| L33422 |
Brain Natriuretic Peptide (BNP) Level-Palmetto GBA |
10/01/2015 |
| L33423 |
Cardiac Computed Tomography & Angiography (CCTA)-Palmetto GBA |
10/01/2015 |
| L33428 |
Cosmetic and Reconstructive Surgery-Palmetto GBA |
10/01/2015 |
| L33431 |
HbA1c-Palmetto GBA |
10/01/2015 |
| L33432 |
Hyaluronate Polymers-Palmetto GBA |
10/01/2015 |
| L33433 |
Infectious Disease Molecular Diagnostic Testing-Palmetto GBA |
10/01/2015 |
| L33434 |
K-ras Testing Required before Epidermal Growth Factor Receptor Antibody Use in Colorectal Cancer-Palmetto GBA |
10/01/2015 |
| L33436 |
Mohs Micrographic Surgery (MMS)-Palmetto GBA |
10/01/2015 |
| L33438 |
Octreotide Acetate for Injectable Suspension (Sandostatin LAR depot)-Palmetto GBA |
10/01/2015 |
| L33443 |
Posterior Tibial Nerve Stimulation (PTNS) for Urinary Control-Palmetto GBA |
10/01/2015 |
| L33444 |
Pulmonary Stress Testing-Palmetto GBA |
10/01/2015 |
| L33445 |
Removal of Benign and Malignant Skin Lesions-Palmetto GBA |
10/01/2015 |
| L33446 |
Respiratory Therapy and Oximetry Services-Palmetto GBA |
10/01/2015 |
| L33447 |
Special Electroencephalography-Palmetto GBA |
10/01/2015 |
| L33448 |
Stress Echocardiography-Palmetto GBA |
10/01/2015 |
| L33449 |
Swallowing Studies for Dysphagia-Palmetto GBA |
10/01/2015 |
| L33452 |
Virtual Colonoscopy (CT Colonography)-Palmetto GBA |
10/01/2015 |
| L33454 |
Varicose Veins of the Lower Extremities-Palmetto GBA |
10/01/2015 |
| L33455 |
Wireless Gastrointestinal Motility Monitoring Systems-Palmetto GBA |
10/01/2015 |
| L33456 |
Total Joint Arthroplasty-Palmetto GBA |
10/01/2015 |
| L33457 |
Cardiac Radionuclide Imaging-Palmetto GBA |
10/01/2015 |
| L33458 |
Chemodenervation-Palmetto GBA |
10/01/2015 |
| L33459 |
Computerized Axial Tomography (CT), Thorax-Palmetto GBA |
10/01/2015 |
| L33461 |
Implantable Infusion Pump-Palmetto GBA |
10/01/2015 |
| L33464 |
MRI of a Joint-Palmetto GBA |
10/01/2015 |
| L33467 |
Ophthalmology: Extended Ophthalmoscopy and Fundus Photography-Palmetto GBA |
10/01/2015 |
| L33468 |
Oral Maxillofacial Prosthesis-Palmetto GBA |
10/01/2015 |
| L33471 |
Transesophageal Echocardiography (TEE)-Palmetto GBA |
10/01/2015 |
| L33472 |
Transthoracic Echocardiography (TTE)-Palmetto GBA |
10/01/2015 |
| L33473 |
Vertebroplasty/Kyphoplasty-Palmetto GBA |
10/01/2015 |
| L33504 |
Intravitreal Bevacizumab (Avastin®)-First Coast Service Options, Inc. |
10/01/2015 |
| L33538 |
Radiation Therapy for T1 Basal Cell and Squamous Cell Carcinomas of the Skin-First Coast Service Options, Inc. |
10/01/2015 |
| L33556 |
Vitamin D Assay Testing-National Government Services, Inc. |
10/01/2015 |
| L33557 |
Cardiac Catheterization and Coronary Angiography-National Government Services, Inc. |
10/01/2015 |
| L33558 |
Cataract Extraction-National Government Services, Inc. |
10/01/2015 |
| L33559 |
Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA)-National Government Services, Inc. |
10/01/2015 |
| L33560 |
Cardiovascular Nuclear Medicine-National Government Services, Inc. |
10/01/2015 |
| L33562 |
Computed Tomographic (CT) Colonography for Diagnostic Uses-National Government Services, Inc. |
10/01/2015 |
| L33563 |
Incision and Drainage (I & D) of Abscess of Skin, Subcutaneous and Accessory Structures-National Government Services, Inc. |
10/01/2015 |
| L33566 |
Wound Debridement Services-First Coast Service Options, Inc. |
10/01/2015 |
| L33567 |
Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)-National Government Services, Inc. |
10/01/2015 |
| L33569 |
Vertebroplasty and Vertebral Augmentation (Percutaneous)-National Government Services, Inc. |
10/01/2015 |
| L33571 |
Destruction of Internal Hemorrhoid(s) by Infrared Coagulation (IRC)-First Coast Service Options, Inc. |
10/01/2015 |
| L33573 |
B-type Natriuretic Peptide (BNP) Testing-National Government Services, Inc. |
10/01/2015 |
| L33574 |
Visual Fields Testing-National Government Services, Inc. |
10/01/2015 |
| L33575 |
Varicose Veins of the Lower Extremity, Treatment of-National Government Services, Inc. |
10/01/2015 |
| L33576 |
Urodynamics-National Government Services, Inc. |
10/01/2015 |
| L33577 |
Transthoracic Echocardiography (TTE)-National Government Services, Inc. |
10/01/2015 |
| L33578 |
Transrectal Ultrasound-National Government Services, Inc. |
10/01/2015 |
| L33579 |
Transesophageal Echocardiography (TEE)-National Government Services, Inc. |
10/01/2015 |
| L33580 |
Speech-Language Pathology-National Government Services, Inc. |
10/01/2015 |
| L33583 |
Diagnostic and Therapeutic Esophagogastroduodenoscopy-First Coast Service Options, Inc. |
10/01/2015 |
| L33584 |
Implantable Miniature Telescope (IMT)-National Government Services, Inc. |
10/01/2015 |
| L33585 |
Breast Imaging: Breast Echography (Sonography)/Breast MRI/Ductography-National Government Services, Inc. |
10/01/2015 |
| L33586 |
Gene Expression Profiling Panel for use in the Management of Breast Cancer Treatment-First Coast Service Options, Inc. |
10/01/2015 |
| L33588 |
Combined Ovarian Cancer Biomarker Tests-National Government Services, Inc. |
10/01/2015 |
| L33591 |
RAST Type Tests-National Government Services, Inc. |
10/01/2015 |
| L33593 |
Implantable Infusion Pump for the Treatment of Chronic Intractable Pain-First Coast Service Options, Inc. |
10/01/2015 |
| L33594 |
Manipulation Under Anesthesia (MUA)-First Coast Service Options, Inc. |
10/01/2015 |
| L33595 |
Monitored Anesthesia Care (MAC) for Certain Interventional Pain Management Services-First Coast Service Options, Inc. |
10/01/2015 |
| L33596 |
Qutenza® (capsaicin) 8% patch-First Coast Service Options, Inc. |
10/01/2015 |
| L33600 |
Sinus X-ray(s)-First Coast Service Options, Inc. |
10/01/2015 |
| L33609 |
Autonomic Function Tests-First Coast Service Options, Inc. |
10/01/2015 |
| L33610 |
Intravenous Immune Globulin-Noridian Administrative Services |
10/01/2015 |
| L33611 |
Oral Appliances for Obstructive Sleep Apnea-Noridian Administrative Services |
10/01/2015 |
| L33612 |
Suction Pumps-Noridian Administrative Services |
10/01/2015 |
| L33613 |
Chiropractic Services-National Government Services, Inc. |
10/01/2015 |
| L33614 |
Debridement Services-National Government Services, Inc. |
10/01/2015 |
| L33615 |
Biofeedback-First Coast Service Options, Inc. |
10/01/2015 |
| L33616 |
Osteopathic Manipulative Treatment-National Government Services, Inc. |
10/01/2015 |
| L33617 |
Erythropoiesis Stimulating Agents (ESA)-National Government Services, Inc. |
10/01/2015 |
| L33618 |
Major Joint Replacement (Hip and Knee)-First Coast Service Options, Inc. |
10/01/2015 |
| L33619 |
Nonvascular Extremity Ultrasound-National Government Services, Inc. |
10/01/2015 |
| L33621 |
Ophthalmic Biometry for Intraocular Lens Power Calculation-National Government Services, Inc. |
10/01/2015 |
| L33622 |
Pain Management-National Government Services, Inc. |
10/01/2015 |
| L33623 |
Percutaneous Coronary Intervention-National Government Services, Inc. |
10/01/2015 |
| L33624 |
Psychiatric Inpatient Hospitalization-National Government Services, Inc. |
10/01/2015 |
| L33626 |
Psychiatric Partial Hospitalization Programs-National Government Services, Inc. |
10/01/2015 |
| L33627 |
Non-Invasive Vascular Studies-National Government Services, Inc. |
10/01/2015 |
| L33628 |
Panretinal (Scatter) Laser Photocoagulation-National Government Services, Inc. |
10/01/2015 |
| L33629 |
Non-covered Services-National Government Services, Inc. |
10/01/2015 |
| L33630 |
Corneal Pachymetry-National Government Services, Inc. |
10/01/2015 |
| L33631 |
Outpatient Physical and Occupational Therapy Services-National Government Services, Inc. |
10/01/2015 |
| L33632 |
Psychiatry and Psychology Services-National Government Services, Inc. |
10/01/2015 |
| L33633 |
Magnetic Resonance Angiography (MRA)-National Government Services, Inc. |
10/01/2015 |
| L33636 |
Routine Foot Care and Debridement of Nails-National Government Services, Inc. |
10/01/2015 |
| L33641 |
Orthopedic Footwear-Noridian Administrative Services |
10/01/2015 |
| L33642 |
Pressure Reducing Support Surfaces - Group 2-Noridian Administrative Services |
10/01/2015 |
| L33646 |
Botulinum Toxins-National Government Services, Inc. |
10/01/2015 |
| L33661 |
Flow Cytometry-First Coast Service Options, Inc. |
10/01/2015 |
| L33667 |
Duplex Scan Of Lower Extremity Arteries-First Coast Service Options, Inc. |
10/01/2015 |
| L33669 |
Electrocardiography-First Coast Service Options, Inc. |
10/01/2015 |
| L33670 |
Fundus Photography-First Coast Service Options, Inc. |
10/01/2015 |
| L33671 |
Diagnostic Colonoscopy-First Coast Service Options, Inc. |
10/01/2015 |
| L33674 |
Duplex Scanning-First Coast Service Options, Inc. |
10/01/2015 |
| L33684 |
Hemophilia Clotting Factors-First Coast Service Options, Inc. |
10/01/2015 |
| L33685 |
Luteinizing Hormone-Releasing Hormone (LHRH) Analogs-First Coast Service Options, Inc. |
10/01/2015 |
| L33686 |
Ankle-Foot/Knee-Ankle-Foot Orthosis-Noridian Administrative Services |
10/01/2015 |
| L33689 |
Mohs Micrographic Surgery (MMS)-First Coast Service Options, Inc. |
10/01/2015 |
| L33690 |
Automatic External Defibrillators-Noridian Administrative Services |
10/01/2015 |
| L33692 |
Pressure Reducing Support Surfaces - Group 3-Noridian Administrative Services |
10/01/2015 |
| L33693 |
Non-Invasive Evaluation of Extremity Veins-First Coast Service Options, Inc. |
10/01/2015 |
| L33695 |
Non-invasive Extracranial Arterial Studies-First Coast Service Options, Inc. |
10/01/2015 |
| L33696 |
Noninvasive Physiologic Studies of Upper or Lower Extremity Arteries-First Coast Service Options, Inc. |
10/01/2015 |
| L33704 |
Infliximab (Remicade TM )-First Coast Service Options, Inc. |
10/01/2015 |
| L33705 |
Ocular Photodynamic Therapy (OPT) with Verteporfin-First Coast Service Options, Inc. |
10/01/2015 |
| L33707 |
Pulmonary Diagnostic Services-First Coast Service Options, Inc. |
10/01/2015 |
| L33708 |
Plerixafor (Mozobil ®)-First Coast Service Options, Inc. |
10/01/2015 |
| L33715 |
Renal Angiography-First Coast Service Options, Inc. |
10/01/2015 |
| L33718 |
Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea-Noridian Administrative Services |
10/01/2015 |
| L33721 |
Computed Tomography Scans of the Head or Brain-First Coast Service Options, Inc. |
10/01/2015 |
| L33722 |
Doxorubicin, Liposomal (Doxil/Lipodox)-First Coast Service Options, Inc. |
10/01/2015 |
| L33723 |
Etoposide (Etopophos®, Toposar®, Vepesid®, VP-16)-First Coast Service Options, Inc. |
10/01/2015 |
| L33726 |
Gemcitabine (Gemzar)-First Coast Service Options, Inc. |
10/01/2015 |
| L33727 |
Irinotecan-First Coast Service Options, Inc. |
10/01/2015 |
| L33729 |
Oxaliplatin (Eloxatin®)-First Coast Service Options, Inc. |
10/01/2015 |
| L33730 |
Paclitaxel (Taxol®)-First Coast Service Options, Inc. |
10/01/2015 |
| L33733 |
Canes and Crutches-Noridian Administrative Services |
10/01/2015 |
| L33735 |
Cold Therapy-Noridian Administrative Services |
10/01/2015 |
| L33736 |
Commodes-Noridian Administrative Services |
10/01/2015 |
| L33737 |
Eye Prostheses-Noridian Administrative Services |
10/01/2015 |
| L33738 |
Facial Prostheses-Noridian Administrative Services |
10/01/2015 |
| L33739 |
Speech Generating Devices (SGD)-Noridian Administrative Services |
10/01/2015 |
| L33745 |
Respiratory Therapeutic Services-First Coast Service Options, Inc. |
10/01/2015 |
| L33746 |
Rituximab (Rituxan®)-First Coast Service Options, Inc. |
10/01/2015 |
| L33747 |
Pegfilgrastim (Neulasta®)-First Coast Service Options, Inc. |
10/01/2015 |
| L33748 |
Romiplostim (Nplate®)-First Coast Service Options, Inc. |
10/01/2015 |
| L33751 |
Scanning Computerized Ophthalmic Diagnostic Imaging-First Coast Service Options, Inc. |
10/01/2015 |
| L33752 |
Topotecan Hydrochloride (Hycamtin®)-First Coast Service Options, Inc. |
10/01/2015 |
| L33754 |
Syphilis Test-First Coast Service Options, Inc. |
10/01/2015 |
| L33755 |
Susceptibility Studies-First Coast Service Options, Inc. |
10/01/2015 |
| L33756 |
Transesophageal Echocardiogram-First Coast Service Options, Inc. |
10/01/2015 |
| L33762 |
Treatment of varicose veins of the lower extremity-First Coast Service Options, Inc. |
10/01/2015 |
| L33763 |
Vascular Stenting of Lower Extremity Arteries-First Coast Service Options, Inc. |
10/01/2015 |
| L33765 |
Blepharoplasty, Eyelid Surgery, and Brow Lift-Palmetto GBA |
10/01/2015 |
| L33766 |
Visual Field Examination-First Coast Service Options, Inc. |
10/01/2015 |
| L33767 |
Viscosupplementation Therapy For Knee-First Coast Service Options, Inc. |
10/01/2015 |
| L33768 |
Transthoracic Echocardiography (TTE)-First Coast Service Options, Inc. |
10/01/2015 |
| L33771 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed-First Coast Service Options, Inc. |
10/01/2015 |
| L33774 |
Wireless Capsule Endoscopy-First Coast Service Options, Inc. |
10/01/2015 |
| L33777 |
Noncovered Services-First Coast Service Options, Inc. |
10/01/2015 |
| L33783 |
Enteral Nutrition-Noridian Administrative Services |
10/01/2015 |
| L33784 |
Heating Pads and Heat Lamps-Noridian Administrative Services |
10/01/2015 |
| L33785 |
High Frequency Chest Wall Oscillation Devices-Noridian Administrative Services |
10/01/2015 |
| L33786 |
Intrapulmonary Percussive Ventilation System-Noridian Administrative Services |
10/01/2015 |
| L33787 |
Lower Limb Prostheses-Noridian Administrative Services |
10/01/2015 |
| L33788 |
Manual Wheelchair Bases-Noridian Administrative Services |
10/01/2015 |
| L33789 |
Power Mobility Devices-Noridian Administrative Services |
10/01/2015 |
| L33790 |
Spinal Orthoses: TLSO and LSO-Noridian Administrative Services |
10/01/2015 |
| L33791 |
Walkers-Noridian Administrative Services |
10/01/2015 |
| L33792 |
Wheelchair Options/Accessories-Noridian Administrative Services |
10/01/2015 |
| L33793 |
Refractive Lenses-Noridian Administrative Services |
10/01/2015 |
| L33794 |
External Infusion Pumps-Noridian Administrative Services |
10/01/2015 |
| L33795 |
Mechanical In-exsufflation Devices-Noridian Administrative Services |
10/01/2015 |
| L33796 |
Osteogenesis Stimulators-Noridian Administrative Services |
10/01/2015 |
| L33797 |
Oxygen and Oxygen Equipment-Noridian Administrative Services |
10/01/2015 |
| L33798 |
Parenteral Nutrition-Noridian Administrative Services |
10/01/2015 |
| L33799 |
Patient Lifts-Noridian Administrative Services |
10/01/2015 |
| L33800 |
Respiratory Assist Devices-Noridian Administrative Services |
10/01/2015 |
| L33801 |
Seat Lift Mechanisms-Noridian Administrative Services |
10/01/2015 |
| L33802 |
Transcutaneous Electrical Nerve Stimulators (TENS)-Noridian Administrative Services |
10/01/2015 |
| L33803 |
Urological Supplies-Noridian Administrative Services |
10/01/2015 |
| L33804 |
Allergen Immunotherapy-First Coast Service Options, Inc. |
10/01/2015 |
| L33807 |
Caspofungin acetate (Cancidas(R))-First Coast Service Options, Inc. |
10/01/2015 |
| L33808 |
Cataract Extraction-First Coast Service Options, Inc. |
10/01/2015 |
| L33809 |
Chelation Therapy-First Coast Service Options, Inc. |
10/01/2015 |
| L33810 |
Computerized Corneal Topography-First Coast Service Options, Inc. |
10/01/2015 |
| L33811 |
Corticotropin-First Coast Service Options, Inc. |
10/01/2015 |
| L33812 |
Destruction by neurolytic agent; interdigital nerve of the foot—Morton’s Neuroma-First Coast Service Options, Inc. |
10/01/2015 |
| L33813 |
Destruction of Malignant Skin Lesions-First Coast Service Options, Inc. |
10/01/2015 |
| L33814 |
Destruction of Paravertebral Facet Joint Nerve(s)-First Coast Service Options, Inc. |
10/01/2015 |
| L33815 |
Diagnostic Nasal Endoscopy-First Coast Service Options, Inc. |
10/01/2015 |
| L33816 |
Duplex scan for erectile dysfunction-First Coast Service Options, Inc. |
10/01/2015 |
| L33817 |
E&M Home and Domiciliary Visits-First Coast Service Options, Inc. |
10/01/2015 |
| L33818 |
Excision of Malignant Skin Lesions-First Coast Service Options, Inc. |
10/01/2015 |
| L33819 |
External Ocular Photography-First Coast Service Options, Inc. |
10/01/2015 |
| L33820 |
Hospital Beds And Accessories-Noridian Administrative Services |
10/01/2015 |
| L33821 |
Negative Pressure Wound Therapy Pumps-Noridian Administrative Services |
10/01/2015 |
| L33822 |
Glucose Monitors-Noridian Administrative Services |
10/01/2015 |
| L33823 |
Cervical Traction Devices-Noridian Administrative Services |
10/01/2015 |
| L33824 |
Immunosuppressive Drugs-Noridian Administrative Services |
10/01/2015 |
| L33825 |
Infrared Heating Pad Systems-Noridian Administrative Services |
10/01/2015 |
| L33826 |
Oral Anticancer Drugs-Noridian Administrative Services |
10/01/2015 |
| L33827 |
Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics)-Noridian Administrative Services |
10/01/2015 |
| L33828 |
Ostomy Supplies-Noridian Administrative Services |
10/01/2015 |
| L33829 |
Pneumatic Compression Devices-Noridian Administrative Services |
10/01/2015 |
| L33830 |
Pressure Reducing Support Surfaces - Group 1-Noridian Administrative Services |
10/01/2015 |
| L33831 |
Surgical Dressings-Noridian Administrative Services |
10/01/2015 |
| L33832 |
Tracheostomy Care Supplies-Noridian Administrative Services |
10/01/2015 |
| L33833 |
Surgical Treatment of Nails-First Coast Service Options, Inc. |
10/01/2015 |
| L33834 |
Health and Behavior Assessment/Intervention-First Coast Service Options, Inc. |
10/01/2015 |
| L33902 |
Comprehensive Motion Analysis Studies-First Coast Service Options, Inc. |
10/01/2015 |
| L33903 |
Diagnostic Laryngoscopy-First Coast Service Options, Inc. |
10/01/2015 |
| L33904 |
B-Scan-First Coast Service Options, Inc. |
10/01/2015 |
| L33906 |
Epidural-First Coast Service Options, Inc. |
10/01/2015 |
| L33907 |
Hepatic (Liver) Function Panel-First Coast Service Options, Inc. |
10/01/2015 |
| L33908 |
High Sensitivity C-Reactive Protein (hsCRP)-First Coast Service Options, Inc. |
10/01/2015 |
| L33909 |
Incision and Drainage of Abscess of Skin, Subcutaneous and Accessory Structures-First Coast Service Options, Inc. |
10/01/2015 |
| L33910 |
Independent Diagnostic Testing Facility (IDTF)-First Coast Service Options, Inc. |
10/01/2015 |
| L33911 |
Indocyanine-Green Angiography-First Coast Service Options, Inc. |
10/01/2015 |
| L33912 |
Injection of Trigger Points-First Coast Service Options, Inc. |
10/01/2015 |
| L33913 |
Interferon-First Coast Service Options, Inc. |
10/01/2015 |
| L33914 |
Iridotomy by Laser Surgery-First Coast Service Options, Inc. |
10/01/2015 |
| L33915 |
Label and Off-label Coverage of Outpatient Drugs and Biologicals-First Coast Service Options, Inc. |
10/01/2015 |
| L33917 |
Laser Trabeculoplasty-First Coast Service Options, Inc. |
10/01/2015 |
| L33918 |
Laser Treatment for Psoriasis-First Coast Service Options, Inc. |
10/01/2015 |
| L33919 |
Macugen (pegaptanib sodium injection)-First Coast Service Options, Inc. |
10/01/2015 |
| L33920 |
Mastoidectomy Cavity Debridement-First Coast Service Options, Inc. |
10/01/2015 |
| L33922 |
Nail Debridement-First Coast Service Options, Inc. |
10/01/2015 |
| L33923 |
Noninvasive Ear or Pulse Oximetry For Oxygen Saturation-First Coast Service Options, Inc. |
10/01/2015 |
| L33924 |
Omalizumab (Xolair®)-First Coast Service Options, Inc. |
10/01/2015 |
| L33925 |
Ophthalmological Diagnostic Services-First Coast Service Options, Inc. |
10/01/2015 |
| L33926 |
Oprelvekin (Neumega®)-First Coast Service Options, Inc. |
10/01/2015 |
| L33927 |
Optical Coherence Biometry-First Coast Service Options, Inc. |
10/01/2015 |
| L33928 |
Osteogenic Stimulation-First Coast Service Options, Inc. |
10/01/2015 |
| L33929 |
Osteopathic Manipulative Treatment-First Coast Service Options, Inc. |
10/01/2015 |
| L33930 |
Paravertebral Facet Joint Blocks-First Coast Service Options, Inc. |
10/01/2015 |
| L33933 |
Peripheral Nerve Blocks-First Coast Service Options, Inc. |
10/01/2015 |
| L33934 |
Physician Certification and Recertification of Home Health Services-First Coast Service Options, Inc. |
10/01/2015 |
| L33935 |
Post-Voiding Residual Ultrasound-First Coast Service Options, Inc. |
10/01/2015 |
| L33937 |
Proton Beam Radiotherapy-First Coast Service Options, Inc. |
10/01/2015 |
| L33939 |
Reduction Mammaplasty-First Coast Service Options, Inc. |
10/01/2015 |
| L33941 |
Routine Foot Care-First Coast Service Options, Inc. |
10/01/2015 |
| L33942 |
Physical Therapy - Home Health-CGS Administrators, LLC |
10/01/2015 |
| L33943 |
B-type Natriuretic Peptide (BNP) Testing-CGS Administrators, LLC |
10/01/2015 |
| L33944 |
Blepharoplasty-CGS Administrators, LLC |
10/01/2015 |
| L33945 |
Cerumen (Earwax) Removal-CGS Administrators, LLC |
10/01/2015 |
| L33946 |
Capsule Opacification Following Cataract Surgery: Discission and YAG Laser Capsulotomy-CGS Administrators, LLC |
10/01/2015 |
| L33947 |
Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA)-CGS Administrators, LLC |
10/01/2015 |
| L33949 |
Botulinum Toxins-CGS Administrators, LLC |
10/01/2015 |
| L33950 |
Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography-CGS Administrators, LLC |
10/01/2015 |
| L33951 |
Circulating Tumor Cell Marker Assays-CGS Administrators, LLC |
10/01/2015 |
| L33952 |
Cardiac Event Detection-CGS Administrators, LLC |
10/01/2015 |
| L33954 |
Cataract Extraction-CGS Administrators, LLC |
10/01/2015 |
| L33957 |
Sacroiliac Joint Injection-First Coast Service Options, Inc. |
10/01/2015 |
| L33958 |
Somatosensory Testing-First Coast Service Options, Inc. |
10/01/2015 |
| L33959 |
Cardiac Catheterization and Coronary Angiography-CGS Administrators, LLC |
10/01/2015 |
| L33960 |
Cardiovascular Nuclear Medicine-CGS Administrators, LLC |
10/01/2015 |
| L33961 |
Therapy Services billed by Physicians/Nonphysician Practitioners -First Coast Service Options, Inc. |
10/01/2015 |
| L33963 |
Tympanometry-First Coast Service Options, Inc. |
10/01/2015 |
| L33965 |
Urinary Tumor Markers for Bladder Cancer-First Coast Service Options, Inc. |
10/01/2015 |
| L33966 |
Vestibular Function Tests-First Coast Service Options, Inc. |
10/01/2015 |
| L33967 |
Vitamin B 12 Injections-First Coast Service Options, Inc. |
10/01/2015 |
| L33968 |
Yag Laser Capsulotomy-First Coast Service Options, Inc. |
10/01/2015 |
| L33969 |
Diagnostic Aerosol or Vapor Inhalation-First Coast Service Options, Inc. |
10/01/2015 |
| L33970 |
Frequency of Hemodialysis Services-First Coast Service Options, Inc. |
10/01/2015 |
| L33972 |
Psychiatric Partial Hospitalization Program-First Coast Service Options, Inc. |
10/01/2015 |
| L33974 |
Troponin-First Coast Service Options, Inc. |
10/01/2015 |
| L33975 |
Psychiatric Inpatient Hospitalization-First Coast Service Options, Inc. |
10/01/2015 |
| L33977 |
Transcranial Doppler Studies-First Coast Service Options, Inc. |
10/01/2015 |
| L33978 |
Pemetrexed-First Coast Service Options, Inc. |
10/01/2015 |
| L33979 |
Benign Skin Lesion Removal (Excludes Actinic Keratosis, and Mohs)-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L33982 |
Chiropractic Services-CGS Administrators, LLC |
10/01/2015 |
| L33985 |
Transplantation Immune Cell Function Assay (ImmuKnow®)-First Coast Service Options, Inc. |
10/01/2015 |
| L33987 |
Computerized Dynamic Posturography-First Coast Service Options, Inc. |
10/01/2015 |
| L33989 |
Docetaxel (Taxotere®)-First Coast Service Options, Inc. |
10/01/2015 |
| L33990 |
Doxorubicin HCl-First Coast Service Options, Inc. |
10/01/2015 |
| L33991 |
Endoscopic and Percutaneous Lysis of Epidural Adhesions-First Coast Service Options, Inc. |
10/01/2015 |
| L33996 |
Vitamin D Assay Testing-CGS Administrators, LLC |
10/01/2015 |
| L33997 |
Fluorescein Angiography-First Coast Service Options, Inc. |
10/01/2015 |
| L33998 |
Fulvestrant (Faslodex®)-First Coast Service Options, Inc. |
10/01/2015 |
| L33999 |
Corneal Pachymetry-CGS Administrators, LLC |
10/01/2015 |
| L34000 |
Ganciclovir and Cidofovir-First Coast Service Options, Inc. |
10/01/2015 |
| L34001 |
Vinorelbine Tartrate (Navelbine®)-First Coast Service Options, Inc. |
10/01/2015 |
| L34002 |
G-CSF ( Neupogen®, Granix™,Zarxio™ )-First Coast Service Options, Inc. |
10/01/2015 |
| L34003 |
Hepatitis B Surface Antibody and Surface Antigen-First Coast Service Options, Inc. |
10/01/2015 |
| L34005 |
Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy-CGS Administrators, LLC |
10/01/2015 |
| L34006 |
Interspinous Process Decompression-First Coast Service Options, Inc. |
10/01/2015 |
| L34007 |
Intravenous Immune Globulin-First Coast Service Options, Inc. |
10/01/2015 |
| L34008 |
Computerized Corneal Topography-CGS Administrators, LLC |
10/01/2015 |
| L34009 |
Chiropractic Services-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34010 |
Treatment of Varicose Veins of the Lower Extremities-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34011 |
Ionized Calcium-First Coast Service Options, Inc. |
10/01/2015 |
| L34012 |
Leucovorin (Wellcovorin®)-First Coast Service Options, Inc. |
10/01/2015 |
| L34013 |
Lung Volume Reduction Surgery-First Coast Service Options, Inc. |
10/01/2015 |
| L34014 |
Magnesium-First Coast Service Options, Inc. |
10/01/2015 |
| L34015 |
Mitomycin (Mutamycin®, Mitomycin-C)-First Coast Service Options, Inc. |
10/01/2015 |
| L34017 |
Ophthalmoscopy-First Coast Service Options, Inc. |
10/01/2015 |
| L34018 |
Parathormone (Parathyroid Hormone)-First Coast Service Options, Inc. |
10/01/2015 |
| L34019 |
Rho (D) Immune Globulin Intravenous-First Coast Service Options, Inc. |
10/01/2015 |
| L34020 |
Sargramostim (GM-CSF, Leukine ®)-First Coast Service Options, Inc. |
10/01/2015 |
| L34021 |
Sedimentation Rate, Erythrocyte-First Coast Service Options, Inc. |
10/01/2015 |
| L34022 |
Serum Phosphorus-First Coast Service Options, Inc. |
10/01/2015 |
| L34023 |
Strapping-First Coast Service Options, Inc. |
10/01/2015 |
| L34025 |
Surgical Decompression for Peripheral Polyneuropathy-First Coast Service Options, Inc. |
10/01/2015 |
| L34026 |
Trastuzumab (Herceptin®)-First Coast Service Options, Inc. |
10/01/2015 |
| L34027 |
Ultrasound, Soft Tissues of Head and Neck-First Coast Service Options, Inc. |
10/01/2015 |
| L34028 |
Upper Eyelid and Brow Surgical Procedures-First Coast Service Options, Inc. |
10/01/2015 |
| L34029 |
Urinalysis-First Coast Service Options, Inc. |
10/01/2015 |
| L34031 |
Total Calcium-First Coast Service Options, Inc. |
10/01/2015 |
| L34032 |
Debridement Services-CGS Administrators, LLC |
10/01/2015 |
| L34037 |
Flow Cytometry-CGS Administrators, LLC |
10/01/2015 |
| L34038 |
B-type Natriuretic Peptide (BNP) Testing-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34040 |
Polysomnography and Other Sleep Studies-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34042 |
Creatine Kinase (CK), (CPK)-First Coast Service Options, Inc. |
10/01/2015 |
| L34043 |
Dysphagia/Swallowing Diagnosis and Therapy-First Coast Service Options, Inc. |
10/01/2015 |
| L34045 |
Non-Invasive Vascular Studies-CGS Administrators, LLC |
10/01/2015 |
| L34046 |
Speech-Language Pathology-CGS Administrators, LLC |
10/01/2015 |
| L34048 |
Vertebroplasty and Vertebral Augmentation (Percutaneous)-CGS Administrators, LLC |
10/01/2015 |
| L34049 |
Outpatient Physical and Occupational Therapy Services-CGS Administrators, LLC |
10/01/2015 |
| L34051 |
Vitamin D Assay Testing-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34052 |
Chest X-Ray Policy-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34053 |
Application of Cellular and/or Tissue Based Products (CTPs) for Wounds of Lower Extremities-CGS Administrators, LLC |
10/01/2015 |
| L34054 |
B-type Natriuretic Peptide (BNP) Testing-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34055 |
Virtual Colonoscopy (CT Colonography)-CGS Administrators, LLC |
10/01/2015 |
| L34056 |
Urodynamics-CGS Administrators, LLC |
10/01/2015 |
| L34057 |
B-type Natriuretic Peptide (BNP) Testing-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34059 |
Serum Magnesium-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34061 |
Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)-CGS Administrators, LLC |
10/01/2015 |
| L34062 |
Dialysis Access Maintenance-CGS Administrators, LLC |
10/01/2015 |
| L34063 |
RAST Type Tests-CGS Administrators, LLC |
10/01/2015 |
| L34064 |
Panretinal (Scatter) Laser Photocoagulation-CGS Administrators, LLC |
10/01/2015 |
| L34066 |
Circulating Tumor Cell Marker Assays-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34072 |
Sensory Evoked Potentials & Intraoperative Neurophysiology Monitoring-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34074 |
Immune Globulin Intravenous (IVIg)-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34076 |
Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34080 |
Intensity Modulated Radiation Therapy (IMRT)-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34081 |
Endoscopy by Capsule-CGS Administrators, LLC |
10/01/2015 |
| L34082 |
Varicose Veins of the Lower Extremity, Treatment of-CGS Administrators, LLC |
10/01/2015 |
| L34084 |
Transcatheter Infusion Therapy-CGS Administrators, LLC |
10/01/2015 |
| L34085 |
Post-Void Residual Urine and/or Bladder Capacity by Ultrasound-CGS Administrators, LLC |
10/01/2015 |
| L34086 |
Polysomnography and Sleep Studies-CGS Administrators, LLC |
10/01/2015 |
| L34087 |
Surveillance of Implantable or Wearable Cardioverter Defibrillators (ICDs): Office, Hospital, Web, or Non-Web Based-CGS Administrators, LLC |
10/01/2015 |
| L34089 |
Human Papillomavirus (HPV) Testing-CGS Administrators, LLC |
10/01/2015 |
| L34090 |
Laser Ablation of the Prostate-CGS Administrators, LLC |
10/01/2015 |
| L34092 |
Immune Globulin Intravenous (IVIg)-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34093 |
Chemotherapy and Biologicals-CGS Administrators, LLC |
10/01/2015 |
| L34094 |
Vitamin D Assay Testing-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34097 |
Chest X-Ray Policy-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34100 |
Monitored Anesthesia Care (MAC)-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34106 |
Percutaneous Vertebral Augmentation-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34107 |
Erythropoiesis Stimulating Agents (ESAs)-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34133 |
Cranial Computerized Tomography (CCT) Scans-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34149 |
Respiratory Care (Respiratory Therapy )-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34151 |
Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34163 |
Total Hip Arthroplasty-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34165 |
Erythropoietin Stimulating Agents (ESA)-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34167 |
Erythropoietin Stimulating Agents (ESA)-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34171 |
Nasal Punctum-Nasolacrimal Duct Dilation and Probing with or without Irrigation-CGS Administrators, LLC |
10/01/2015 |
| L34175 |
Ophthalmic Angiography (Fluorescein and Indocyanine Green)-CGS Administrators, LLC |
10/01/2015 |
| L34176 |
Polysomnography and Sleep Studies-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34181 |
Ophthalmic Biometry for Intraocular Lens Power Calculation-CGS Administrators, LLC |
10/01/2015 |
| L34183 |
Psychiatric Inpatient Hospitalization-CGS Administrators, LLC |
10/01/2015 |
| L34194 |
Blepharoplasty, Eyelid Surgery, and Brow Lift-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34195 |
Mohs Micrographic Surgery-CGS Administrators, LLC |
10/01/2015 |
| L34196 |
Psychiatric Partial Hospitalization Programs-CGS Administrators, LLC |
10/01/2015 |
| L34199 |
Treatment of Ulcers & Symptomatic Hyperkeratoses-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34200 |
Removal of Benign Skin Lesions-CGS Administrators, LLC |
10/01/2015 |
| L34202 |
Erythropoiesis Stimulating Agents (ESAs)-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34203 |
Cataract Surgery in Adults-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34209 |
Treatment of Varicose Veins of the Lower Extremities-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34211 |
Trigger Point Injections-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34213 |
Diagnostic and Therapeutic Colonoscopy -Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34215 |
Flow Cytometry-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34216 |
Polysomnography and Sleep Studies for Testing Sleep and Respiratory Disorders-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34217 |
Intensity Modulated Radiation Therapy (IMRT)-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34218 |
Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34219 |
Noninvasive Peripheral Arterial Studies-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34220 |
Lumbar MRI-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34221 |
Noninvasive Cerebrovascular Studies-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34223 |
Stereotactic Radiosurgery-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34224 |
Stereotactic Body Radiation Therapy-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34228 |
Percutaneous Vertebral Augmentation-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34229 |
Noninvasive Peripheral Venous Studies-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34233 |
Benign Skin Lesion Removal (Excludes Actinic Keratosis, and Mohs)-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34242 |
Chiropractic Services-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34243 |
Treatment of Ulcers & Symptomatic Hyperkeratoses-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34246 |
Routine Foot Care and Debridement of Nails-CGS Administrators, LLC |
10/01/2015 |
| L34247 |
Pulmonary Function Testing-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34252 |
Drugs and Biologicals: Antiangiogenic Therapy for Ophthalmic Conditions-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34253 |
Drugs and Biologicals: Botulinum Toxins-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34254 |
Drugs and Biologicals: Colony Stimulating Factors-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34255 |
Drugs and Biologicals: Erythropoietin Analogues-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34256 |
Drugs and Biologicals: Immune Globulin Intravenous (IVIg)-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34257 |
Drugs and Biologicals: Infliximab (REMICADE ®)-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34258 |
Drugs and Biologicals: Octreotide Acetate for Injectable Suspension (Sandostatin LAR ® Depot)-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34259 |
Drugs and Biologicals: Palonosetron HCL Injection (Aloxi ™)-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34260 |
Drugs and Biologicals: Zoledronic Acid-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34261 |
Medicine: Chiropractic Services-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34262 |
Medicine: Health and Behavior Assessment/Intervention-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34263 |
Medicine: Hydration Therapy-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34264 |
Medicine: Long-Term Wearable Electrocardiographic Monitoring (WEM)-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34266 |
Medicine: Neurophysiology Evoked Potentials (NEPs)-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34267 |
Medicine: Noninvasive Peripheral Arterial and Venous Studies-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34268 |
Medicine: Noninvasive Vascular Studies of Abdominal, Pelvic, Scrotal Contents and/or Retroperitoneal Organs-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34269 |
Medicine: Repetitive Transcranial Magnetic Stimulation (rTMS) for Resistant Depression-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34270 |
Medicine: Wireless Capsule Imaging-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34271 |
Pathology and Laboratory: B-type Natriuretic Peptide (BNP) Testing-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34272 |
Pathology and Laboratory: C-Reactive Protein; High Sensitivity (hsCRP)-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34273 |
Pathology and Laboratory: Circulating Tumor Cells (CTC) Assays-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34274 |
Pathology and Laboratory: Vitamin D Assay Testing-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34275 |
Radiology: Computed Tomographic (CT) Colonography-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34276 |
Radiology: Computed Tomographic Angiography of the Heart and Coronary Vessels-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34277 |
Radiology: Computed Tomography of the Abdomen and Pelvis-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34278 |
Radiology: Magnetic Resonance Imaging of the Brain-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34279 |
Radiology: Myocardial Perfusion Imaging (MPI)-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34280 |
Radiology: Nonobstetric Pelvic Ultrasound-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34281 |
Radiology: PET for Myocardial Perfusion Imaging (MPI) and Myocardial Viability (MV)-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34282 |
Radiology: Proton Beam Therapy-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34283 |
Radiology: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34284 |
Surgery: Arthrocentesis, Aspiration, and/or Injection; Major Joint or Bursa-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34285 |
Surgery: Bioengineered Skin Substitutes (BSS) for the Treatment of Diabetic and Venous Stasis Ulcers of the Lower Extremities-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34286 |
Surgery: Blepharoplasty-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34287 |
Surgery: Cataract Extraction-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34288 |
Surgery: Colonoscopy (Diagnostic)-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34289 |
Surgery: Continuous Peripheral Nerve Blocks (CPNB)-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34290 |
Surgery: Debridement Services-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34291 |
Surgery: Injections of the Spinal Canal-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34292 |
Surgery: Interventional Renal Denervation (IRD) for Resistant Hypertension-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34293 |
Surgery: Lumbar Facet Blockade-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34294 |
Surgery: Major Joint Replacement (Hip and Knee)-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34295 |
Surgery: Nerve Blocks and Electrostimulation for Peripheral Neuropathy-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34296 |
Surgery: Posterior Tibial Nerve Stimulation (PTNS) for Urinary Control-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34297 |
Surgery: Removal of Benign or Premalignant Skin Lesions-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34298 |
Surgery: Transoral Incisionless Fundoplication (TIF)-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34299 |
Surgery: Trigger Point Injections-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34300 |
Surgery: Vertebral Augmentation Procedures (VAPs)-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34301 |
Surgery: YAG Capsulotomy-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34302 |
Transportation Services: Ambulance-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34303 |
Drugs and Biologicals: Bevacizumab (AVASTIN®)-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34304 |
Drugs and Biologicals: Gemcitabine Hydrochloride (Gemzar ®)-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34305 |
Drugs and Biologicals: Oxaliplatin (Eloxatin ®)-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34306 |
Drugs and Biologicals: Rituximab (Rituxan ®)-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34307 |
Medicine: Dysphagia/Swallowing Therapy-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34308 |
Medicine: Occupational Therapy - Outpatient-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34309 |
Medicine: Partial Hospitalization Programs-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34310 |
Medicine: Physical Therapy - Outpatient-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34311 |
Medicine: Speech Language Pathology - Outpatient-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34313 |
Allergy Testing-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34314 |
Immune Globulin Intravenous (IVIg)-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34315 |
Electrocardiograms-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34317 |
Radiologic Examination, Chest-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34324 |
Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34328 |
Peripheral Nerve and Peripheral Nerve Field Stimulation-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34337 |
Transesophageal Echocardiography (TEE)-CGS Administrators, LLC |
10/01/2015 |
| L34338 |
Transthoracic Echocardiography (TTE)-CGS Administrators, LLC |
10/01/2015 |
| L34353 |
Outpatient Psychiatry and Psychology Services-CGS Administrators, LLC |
10/01/2015 |
| L34356 |
Erythropoiesis Stimulating Agents (ESA)-CGS Administrators, LLC |
10/01/2015 |
| L34370 |
Category III CPT® Codes-CGS Administrators, LLC |
10/01/2015 |
| L34372 |
Magnetic Resonance Angiography (MRA)-First Coast Service Options, Inc. |
10/01/2015 |
| L34373 |
Magnetic Resonance Imaging (MRI) of Any Joint of the Lower Extremities-First Coast Service Options, Inc. |
10/01/2015 |
| L34374 |
Magnetic Resonance Imaging of the Brain-First Coast Service Options, Inc. |
10/01/2015 |
| L34375 |
Magnetic Resonance Imaging of the Orbit, Face, and/or Neck-First Coast Service Options, Inc. |
10/01/2015 |
| L34376 |
Magnetic Resonance Imaging of the Spine-First Coast Service Options, Inc. |
10/01/2015 |
| L34377 |
Magnetic Resonance Imaging of Upper Extremity-First Coast Service Options, Inc. |
10/01/2015 |
| L34380 |
Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)-National Government Services, Inc. |
10/01/2015 |
| L34393 |
Ocular Photography - External-CGS Administrators, LLC |
10/01/2015 |
| L34394 |
Visual Fields Testing-CGS Administrators, LLC |
10/01/2015 |
| L34399 |
Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)-CGS Administrators, LLC |
10/01/2015 |
| L34410 |
B-type Natriuretic Peptide (BNP) Testing-Palmetto GBA |
10/01/2015 |
| L34411 |
Blepharoplasty, Eyelid Surgery, and Brow Lift-Palmetto GBA |
10/01/2015 |
| L34412 |
Cardiac Rehabilitation-Palmetto GBA |
10/01/2015 |
| L34413 |
Cataract Surgery-Palmetto GBA |
10/01/2015 |
| L34415 |
CT of the Abdomen and Pelvis-Palmetto GBA |
10/01/2015 |
| L34416 |
Computerized Axial Tomography of the Chest/Thorax-Palmetto GBA |
10/01/2015 |
| L34417 |
CT of the Head-Palmetto GBA |
10/01/2015 |
| L34419 |
Homocysteine Level, Serum-Palmetto GBA |
10/01/2015 |
| L34422 |
Infrared Coagulation (IRC) of Hemorrhoids-Palmetto GBA |
10/01/2015 |
| L34424 |
Magnetic Resonance Angiography-Palmetto GBA |
10/01/2015 |
| L34425 |
Magnetic Resonance Imaging of the Orbit, Face, and/or Neck -Palmetto GBA |
10/01/2015 |
| L34426 |
Ophthalmic Angiography (Fluorescein and Indocyanine Green)-Palmetto GBA |
10/01/2015 |
| L34427 |
Outpatient Occupational Therapy-Palmetto GBA |
10/01/2015 |
| L34428 |
Outpatient Physical Therapy-Palmetto GBA |
10/01/2015 |
| L34429 |
Outpatient Speech Language Pathology-Palmetto GBA |
10/01/2015 |
| L34430 |
Respiratory Therapy (Respiratory Care)-Palmetto GBA |
10/01/2015 |
| L34431 |
Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)-Palmetto GBA |
10/01/2015 |
| L34433 |
Somatosensory Testing-Palmetto GBA |
10/01/2015 |
| L34434 |
Upper Gastrointestinal Endoscopy and Visualization-Palmetto GBA |
10/01/2015 |
| L34436 |
Posterior Tibial Nerve Stimulation (PTNS)-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L34454 |
Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy-Palmetto GBA |
10/01/2015 |
| L34500 |
Medicine: Autonomic Function Tests-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34501 |
Pathology and Laboratory: Qualitative Drug Testing-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34512 |
Corneal Pachymetry-Palmetto GBA |
10/01/2015 |
| L34513 |
Flow Cytometry-Palmetto GBA |
10/01/2015 |
| L34518 |
Molecular Pathology Procedures for Human Leukocyte Antigen (HLA) Typing-First Coast Service Options, Inc. |
10/01/2015 |
| L34519 |
Molecular Pathology Procedures-First Coast Service Options, Inc. |
10/01/2015 |
| L34520 |
Psychological and Neuropsychological Tests-First Coast Service Options, Inc. |
10/01/2015 |
| L34521 |
Special EEG Tests-First Coast Service Options, Inc. |
10/01/2015 |
| L34522 |
Transcranial Magnetic Stimulation for Major Depressive Disorder-First Coast Service Options, Inc. |
10/01/2015 |
| L34525 |
Intra-articular Injections of Hyaluronan-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L34526 |
Surgical Treatment of Obstructive Sleep Apnea (OSA)-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L34528 |
Blepharoplasty, Blepharoptosis and Brow Lift-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L34535 |
Polysomnography and Other Sleep Studies-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L34536 |
Treatment of Varicose Veins of the Lower Extremities-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L34537 |
Vestibular Function Testing-Palmetto GBA |
10/01/2015 |
| L34538 |
Hospice Determining Terminal Status-CGS Administrators, LLC |
10/01/2015 |
| L34539 |
Psychological Services Coverage under the Incident to Provision for Physicians and Non-physicians-CGS Administrators, LLC |
10/01/2015 |
| L34540 |
Stretta Procedure-CGS Administrators, LLC |
10/01/2015 |
| L34541 |
Transtelephonic Spirometry-CGS Administrators, LLC |
10/01/2015 |
| L34544 |
Hospice - Liver Disease-Palmetto GBA |
10/01/2015 |
| L34546 |
Home-Based Fall Evaluations and Interventions-Palmetto GBA |
10/01/2015 |
| L34547 |
Hospice - Neurological Conditions-Palmetto GBA |
10/01/2015 |
| L34548 |
Hospice Cardiopulmonary Conditions-Palmetto GBA |
10/01/2015 |
| L34549 |
Ambulance Services-Palmetto GBA |
10/01/2015 |
| L34551 |
One Day Stays for Chest Pain-Palmetto GBA |
10/01/2015 |
| L34552 |
Outpatient Observation Bed/Room Services-Palmetto GBA |
10/01/2015 |
| L34553 |
Stretta Procedure-Palmetto GBA |
10/01/2015 |
| L34554 |
In Vitro Chemosensitivity & Chemoresistance Assays-Palmetto GBA |
10/01/2015 |
| L34555 |
Non-Covered Category III CPT Codes-Palmetto GBA |
10/01/2015 |
| L34556 |
Spinal Cord Stimulators for Chronic Pain-Palmetto GBA |
10/01/2015 |
| L34558 |
Hospice The Adult Failure To Thrive Syndrome-Palmetto GBA |
10/01/2015 |
| L34559 |
Hospice - Renal Care-Palmetto GBA |
10/01/2015 |
| L34560 |
Home Health Occupational Therapy-Palmetto GBA |
10/01/2015 |
| L34561 |
Home Health - Psychiatric Care-Palmetto GBA |
10/01/2015 |
| L34562 |
Home Health Skilled Nursing Care-Teaching and Training: Alzheimer's Disease and Behavioral Disturbances-Palmetto GBA |
10/01/2015 |
| L34563 |
Home Health Speech-Language Pathology-Palmetto GBA |
10/01/2015 |
| L34564 |
Home Health Physical Therapy-Palmetto GBA |
10/01/2015 |
| L34565 |
Home Health-Surface Electrical Stimulation in the Treatment of Dysphagia-Palmetto GBA |
10/01/2015 |
| L34566 |
Hospice - HIV Disease-Palmetto GBA |
10/01/2015 |
| L34567 |
Hospice Alzheimer's Disease & Related Disorders-Palmetto GBA |
10/01/2015 |
| L34570 |
Psychiatric Inpatient Hospitalization-Palmetto GBA |
10/01/2015 |
| L34573 |
Cardiac Event Detection-Palmetto GBA |
10/01/2015 |
| L34574 |
Dental Services-Palmetto GBA |
10/01/2015 |
| L34575 |
Frequency of Dialysis-Palmetto GBA |
10/01/2015 |
| L34576 |
Laparoscopic Sleeve Gastrectomy for Severe Obesity-Palmetto GBA |
10/01/2015 |
| L34577 |
Retroperitoneal Ultrasound-Palmetto GBA |
10/01/2015 |
| L34578 |
Surface Electrical Stimulation in the Treatment of Dysphagia-Palmetto GBA |
10/01/2015 |
| L34580 |
Intravenous Immunoglobulin (IVIG)-Palmetto GBA |
10/01/2015 |
| L34585 |
Chiropractic Services-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L34587 |
Wound Care-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L34588 |
Trigger Points, Local Injections-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L34592 |
Vertebroplasty (Percutaneous) and Vertebral Augmentation including cavity creation-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L34594 |
Nerve Conduction Studies and Electromyography-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L34596 |
Immunizations-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L34614 |
Colonoscopy and Sigmoidoscopy-Diagnostic-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L34615 |
Visual Fields-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L34616 |
Psychiatry and Psychology Services-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L34623 |
Intraoperative Neurophysiological Testing-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L34624 |
Somatosensory Testing-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L34633 |
Erythropoiesis Stimulating Agents (ESAs)-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L34634 |
Proton Beam Therapy-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L34635 |
Botulinum Toxin Type A & Type B-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L34636 |
Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring)-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L34641 |
Transcranial Magnetic Stimulation (TMS)-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L34645 |
Drug Testing-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L34646 |
Psychological and Neuropsychological Testing-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L34648 |
Bisphosphonate Drug Therapy-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L34651 |
Flow Cytometry-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L34658 |
Vitamin D Assay Testing-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L34659 |
Endoscopic Treatment of GERD-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L34698 |
Cosmetic and Reconstructive Surgery-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L34699 |
Human Granulocyte/Macrophage Colony Stimulating Factors-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L34741 |
Drugs and Biologics (Non-chemotherapy)-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L34760 |
Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L34761 |
Percutaneous Coronary Interventions-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L34762 |
Molecular Diagnostic Testing-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L34771 |
Immune Globulins-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L34807 |
Lumbar Epidural Steroid Injections (ESI)-CGS Administrators, LLC |
10/01/2015 |
| L34821 |
Transcutaneous Electrical Joint Stimulation Devices (TEJSD)-Noridian Administrative Services |
10/01/2015 |
| L34822 |
Luteinizing Hormone-Releasing Hormone (LHRH) Analogs-Novitas Solutions, Inc. |
10/01/2015 |
| L34823 |
Tumor Treatment Field Therapy (TTFT)-Noridian Administrative Services |
10/01/2015 |
| L34824 |
Vacuum Erection Devices (VED)-Noridian Administrative Services |
10/01/2015 |
| L34832 |
Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy-CGS Administrators, LLC |
10/01/2015 |
| L34833 |
Cardiac Rhythm Device Evaluation-Novitas Solutions, Inc. |
10/01/2015 |
| L34834 |
Blood Glucose Monitoring in a Skilled Nursing Facility (SNF)-Novitas Solutions, Inc. |
10/01/2015 |
| L34856 |
C-Reactive Protein High Sensitivity Testing (hsCRP)-Novitas Solutions, Inc. |
10/01/2015 |
| L34859 |
Nerve Conduction Studies and Electromyography-First Coast Service Options, Inc. |
10/01/2015 |
| L34861 |
Infrared Photocoagulation (IRC) of Hemorrhoids-Novitas Solutions, Inc. |
10/01/2015 |
| L34862 |
Co-Management of Surgical Procedures-Novitas Solutions, Inc. |
10/01/2015 |
| L34863 |
Coverage of Services and Procedures in Nursing Facilities-Novitas Solutions, Inc. |
10/01/2015 |
| L34864 |
Loss-of-Heterozygosity Based Topographic Genotyping with PathfinderTG ®-Novitas Solutions, Inc. |
10/01/2015 |
| L34865 |
Magnetic Resonance Angiography (MRA)-Novitas Solutions, Inc. |
10/01/2015 |
| L34869 |
Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder-Palmetto GBA |
10/01/2015 |
| L34887 |
Surgical Treatment of Nails-Novitas Solutions, Inc. |
10/01/2015 |
| L34891 |
Speech-Language Pathology (SLP) Services: Dysphagia; Includes VitalStim® Therapy-Novitas Solutions, Inc. |
10/01/2015 |
| L34892 |
Paravertebral Facet and Sacroiliac Joint Injections-Novitas Solutions, Inc. |
10/01/2015 |
| L34912 |
Genetic Testing for Lynch Syndrome-First Coast Service Options, Inc. |
10/01/2015 |
| L34914 |
Assays for Vitamins and Metabolic Function-Novitas Solutions, Inc. |
10/01/2015 |
| L34924 |
Treatment of Varicose Veins and Venous Stasis Disease of the Lower Extremities-Novitas Solutions, Inc. |
10/01/2015 |
| L34938 |
Removal of Benign Skin Lesions-Novitas Solutions, Inc. |
10/01/2015 |
| L34943 |
Pathology and Laboratory: Molecular Pathology Procedures for Human Leukocyte Antigen (HLA) Typing-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34944 |
Surgery: Routine Foot Care-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L34953 |
Cardiac Event Detection Monitoring-Novitas Solutions, Inc. |
10/01/2015 |
| L34960 |
Hydration Therapy-Novitas Solutions, Inc. |
10/01/2015 |
| L34961 |
Mohs Micrographic Surgery (MMS)-Novitas Solutions, Inc. |
10/01/2015 |
| L34966 |
Benign Skin Lesions-Novitas Solutions, Inc. |
10/01/2015 |
| L34974 |
Facet Joint Injections-Novitas Solutions, Inc. |
10/01/2015 |
| L34975 |
Neurophysiology Evoked Potentials (NEPs)-Novitas Solutions, Inc. |
10/01/2015 |
| L34976 |
Vertebroplasty, Vertebral Augmentation; Percutaneous-First Coast Service Options, Inc. |
10/01/2015 |
| L34977 |
Anorectal Manometry, Anal Electromyography, and Biofeedback Training for Perineal Muscles and Anorectal or Urethral Sphincters-Novitas Solutions, Inc. |
10/01/2015 |
| L34980 |
Lumbar Epidural Injections-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34981 |
Lumbar Epidural Injections-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34982 |
Lumbar Epidural Injections-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34983 |
Lumbar Epidural Injections-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34992 |
Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34993 |
Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34995 |
Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L34996 |
Neuromuscular Junction Testing-Novitas Solutions, Inc. |
10/01/2015 |
| L34997 |
Real-Time, Outpatient Cardiac Telemetry-Novitas Solutions, Inc. |
10/01/2015 |
| L34998 |
Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder -Novitas Solutions, Inc. |
10/01/2015 |
| L34999 |
Transoral Incisionless Fundoplication-Novitas Solutions, Inc. |
10/01/2015 |
| L35000 |
Molecular Pathology Procedures-National Government Services, Inc. |
10/01/2015 |
| L35001 |
Reduction Mammaplasty-National Government Services, Inc. |
10/01/2015 |
| L35003 |
Intraoperative Neurophysiological Testing-Novitas Solutions, Inc. |
10/01/2015 |
| L35004 |
Surgery: Blepharoplasty-Novitas Solutions, Inc. |
10/01/2015 |
| L35006 |
Controlled Substance Monitoring and Drugs of Abuse Testing-Novitas Solutions, Inc. |
10/01/2015 |
| L35007 |
Vestibular and Audiologic Function Studies-Novitas Solutions, Inc. |
10/01/2015 |
| L35008 |
Non-Covered Services-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L35009 |
Prostate Mapping Biopsy-Novitas Solutions, Inc. |
10/01/2015 |
| L35010 |
Trigger Point Injections-Novitas Solutions, Inc. |
10/01/2015 |
| L35011 |
Surgery: Posterior Tibial Nerve Stimulation (PTNS) for Urinary Control-Novitas Solutions, Inc. |
10/01/2015 |
| L35013 |
Debridement of Mycotic Nails-Novitas Solutions, Inc. |
10/01/2015 |
| L35014 |
Frequency of Dialysis-Novitas Solutions, Inc. |
10/01/2015 |
| L35015 |
Molecular Diagnostics: Genitourinary Infectious Disease Testing-Novitas Solutions, Inc. |
10/01/2015 |
| L35016 |
Transesophageal Echocardiography (TEE)-Novitas Solutions, Inc. |
10/01/2015 |
| L35021 |
Hyperbaric Oxygen (HBO) Therapy-Novitas Solutions, Inc. |
10/01/2015 |
| L35022 |
Bariatric Surgical Management of Morbid Obesity-Novitas Solutions, Inc. |
10/01/2015 |
| L35024 |
MolDX: Genetic Testing for Lynch Syndrome-Palmetto GBA |
10/01/2015 |
| L35025 |
MolDX: Molecular Diagnostic Tests (MDT)-Palmetto GBA |
10/01/2015 |
| L35026 |
Rituximab (Rituxan®)-Palmetto GBA |
10/01/2015 |
| L35028 |
Venous Angioplasty with or without Stent Placement for the Treatment of Chronic Cerebrospinal Venous Insufficiency-National Government Services, Inc. |
10/01/2015 |
| L35029 |
Nerve Blocks for Peripheral Neuropathy-National Government Services, Inc. |
10/01/2015 |
| L35032 |
Flow Cytometry-Novitas Solutions, Inc. |
10/01/2015 |
| L35033 |
Pain Management-Novitas Solutions, Inc. |
10/01/2015 |
| L35035 |
Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography-Novitas Solutions, Inc. |
10/01/2015 |
| L35036 |
Therapy and Rehabilitation Services (PT, OT)-Novitas Solutions, Inc. |
10/01/2015 |
| L35038 |
Scanning Computerized Ophthalmic Diagnostic Imaging-Novitas Solutions, Inc. |
10/01/2015 |
| L35041 |
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds-Novitas Solutions, Inc. |
10/01/2015 |
| L35045 |
Cardiac Computed Tomography & Angiography (CCTA)-Palmetto GBA |
10/01/2015 |
| L35047 |
Oral Maxillofacial Prosthesis-Novitas Solutions, Inc. |
10/01/2015 |
| L35048 |
Nerve Conduction Studies and Electromyography-Palmetto GBA |
10/01/2015 |
| L35049 |
Monitored Anesthesia Care-Novitas Solutions, Inc. |
10/01/2015 |
| L35050 |
Outpatient Sleep Studies-Novitas Solutions, Inc. |
10/01/2015 |
| L35053 |
Chemotherapy Drugs and their Adjuncts-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L35062 |
Biomarkers Overview-Novitas Solutions, Inc. |
10/01/2015 |
| L35064 |
Vascular Access for Hemodialysis-Novitas Solutions, Inc. |
10/01/2015 |
| L35068 |
Evaluation and Management Services Provided in a Nursing Facility-Novitas Solutions, Inc. |
10/01/2015 |
| L35070 |
Speech - Language Pathology (SLP) Services: Communication Disorders-Novitas Solutions, Inc. |
10/01/2015 |
| L35071 |
MolDX: Circulating Tumor Cell Marker Assays-Palmetto GBA |
10/01/2015 |
| L35072 |
MolDX: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing-Palmetto GBA |
10/01/2015 |
| L35073 |
MolDX: NRAS Genetic Testing-Palmetto GBA |
10/01/2015 |
| L35074 |
Heavy Metal Testing-National Government Services, Inc. |
10/01/2015 |
| L35075 |
Proton Beam Therapy-National Government Services, Inc. |
10/01/2015 |
| L35076 |
Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)-National Government Services, Inc. |
10/01/2015 |
| L35080 |
Endoscopic Treatment of GERD-National Government Services, Inc. |
10/01/2015 |
| L35081 |
Nerve Conduction Studies and Electromyography-Novitas Solutions, Inc. |
10/01/2015 |
| L35083 |
Cardiovascular Nuclear Medicine-Novitas Solutions, Inc. |
10/01/2015 |
| L35084 |
Non-Coronary Vascular Stents-Novitas Solutions, Inc. |
10/01/2015 |
| L35089 |
Wireless Capsule Endoscopy-Novitas Solutions, Inc. |
10/01/2015 |
| L35090 |
Cosmetic and Reconstructive Surgery-Novitas Solutions, Inc. |
10/01/2015 |
| L35091 |
Cataract Extraction (including Complex Cataract Surgery)-Novitas Solutions, Inc. |
10/01/2015 |
| L35092 |
Diagnostic Abdominal Aortography and Renal Angiography-Novitas Solutions, Inc. |
10/01/2015 |
| L35093 |
Intravenous Immune Globulin (IVIG)-Novitas Solutions, Inc. |
10/01/2015 |
| L35094 |
Services That Are Not Reasonable and Necessary-Novitas Solutions, Inc. |
10/01/2015 |
| L35095 |
Lacrimal Punctum Plugs-Novitas Solutions, Inc. |
10/01/2015 |
| L35098 |
Nerve Conduction Studies and Electromyography-National Government Services, Inc. |
10/01/2015 |
| L35099 |
Frequency of Laboratory Tests-Novitas Solutions, Inc. |
10/01/2015 |
| L35101 |
Psychiatric Codes-Novitas Solutions, Inc. |
10/01/2015 |
| L35107 |
Pain Management of Peripheral Nerves by Injection-Novitas Solutions, Inc. |
10/01/2015 |
| L35111 |
Hemophilia Factor Products-Novitas Solutions, Inc. |
10/01/2015 |
| L35112 |
Implantable Infusion Pump-Novitas Solutions, Inc. |
10/01/2015 |
| L35121 |
Coronary Computed Tomography Angiography (CCTA)-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L35124 |
Autonomic Function Testing-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L35125 |
Wound Care-Novitas Solutions, Inc. |
10/01/2015 |
| L35130 |
Vertebroplasty, Vertebral Augmentation (Kyphoplasty) Percutaneous-Novitas Solutions, Inc. |
10/01/2015 |
| L35132 |
Home Health Plans of Care: Monitoring Glucose Control in the Medicare Home Health Population with Type II Diabetes Mellitus-Palmetto GBA |
10/01/2015 |
| L35136 |
Spinal Cord Stimulators for Chronic Pain-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L35138 |
Routine Foot Care-Novitas Solutions, Inc. |
10/01/2015 |
| L35139 |
Wound Care-Novitas Solutions, Inc. |
10/01/2015 |
| L35148 |
Lumbar Epidural Steroid Injections-Palmetto GBA |
10/01/2015 |
| L35160 |
MolDX: Molecular Diagnostic Tests (MDT)-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L35162 |
Ambulance Services (Ground Ambulance)-Novitas Solutions, Inc. |
10/01/2015 |
| L35163 |
Plastic Surgery-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L35170 |
Botulinum Toxin Types A and B Policy-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L35172 |
Botulinum Toxin Types A and B-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L35175 |
MRI and CT Scans of the Head, Brain, and Neck-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L35177 |
MRI and CT Scans of the Head, Brain, and Neck-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L35178 |
Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L35222 |
Nerve Blocks for Peripheral Neuropathy-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L35249 |
Nerve Blocks for Peripheral Neuropathy-CGS Administrators, LLC |
10/01/2015 |
| L35332 |
MolDX: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing-CGS Administrators, LLC |
10/01/2015 |
| L35349 |
MolDX: Genetic Testing for Lynch Syndrome-CGS Administrators, LLC |
10/01/2015 |
| L35350 |
UPPER GASTROINTESTINAL ENDOSCOPY (DIAGNOSTIC AND THERAPEUTIC)-Novitas Solutions, Inc. |
10/01/2015 |
| L35360 |
Pulmonary Function Testing-Novitas Solutions, Inc. |
10/01/2015 |
| L35391 |
Multiple Imaging in Oncology-Novitas Solutions, Inc. |
10/01/2015 |
| L35395 |
Autonomic Function Tests-Novitas Solutions, Inc. |
10/01/2015 |
| L35396 |
Biomarkers for Oncology-Novitas Solutions, Inc. |
10/01/2015 |
| L35397 |
Non-Invasive Cerebrovascular Arterial Studies-Novitas Solutions, Inc. |
10/01/2015 |
| L35408 |
3D Interpretation and Reporting of Imaging Studies-Novitas Solutions, Inc. |
10/01/2015 |
| L35409 |
Non-Vascular Extremity Ultrasound-Novitas Solutions, Inc. |
10/01/2015 |
| L35424 |
Chiropractic Services-Novitas Solutions, Inc. |
10/01/2015 |
| L35427 |
Hyaluronan Acid Therapies for Osteoarthritis of the Knee-Novitas Solutions, Inc. |
10/01/2015 |
| L35428 |
Thrombolytic Agents-Novitas Solutions, Inc. |
10/01/2015 |
| L35433 |
Barium Swallow Studies, Modified-Novitas Solutions, Inc. |
10/01/2015 |
| L35434 |
Oximetry Services-Novitas Solutions, Inc. |
10/01/2015 |
| L35442 |
MolDX: NRAS Genetic Testing-CGS Administrators, LLC |
10/01/2015 |
| L35443 |
MolDX: GeneSight ® Assay for Refractory Depression-CGS Administrators, LLC |
10/01/2015 |
| L35447 |
Nerve Blockade for Treatment of Chronic Pain and Neuropathy-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L35448 |
Independent Diagnostic Testing Facility (IDTF)-Novitas Solutions, Inc. |
10/01/2015 |
| L35449 |
Sacral Nerve Stimulation-Novitas Solutions, Inc. |
10/01/2015 |
| L35450 |
Spinal Cord Stimulation (Dorsal Column Stimulation)-Novitas Solutions, Inc. |
10/01/2015 |
| L35451 |
Non-Invasive Peripheral Venous Studies-Novitas Solutions, Inc. |
10/01/2015 |
| L35456 |
Nerve Blockade for Treatment of Chronic Pain and Neuropathy-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L35457 |
Nerve Blockade for Treatment of Chronic Pain and Neuropathy-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L35458 |
Nerve Blockade for Treatment of Chronic Pain and Neuropathy-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L35486 |
Pelvic Floor Dysfunction: Anorectal Manometry and EMG-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L35490 |
Category III Codes-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L35494 |
Mohs Micrographic Surgery-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L35498 |
Removal of Benign Skin Lesions-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L35526 |
B-type Natriuretic Peptide (BNP) Testing-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L35553 |
Pathology and Laboratory: Genetic Testing for Lynch Syndrome-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L35554 |
Surgery: Reduction Mammaplasty-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L35627 |
Non-Coverage of Extracorporeal Shock Wave Lithotripsy for Musculoskeletal Conditions-Palmetto GBA |
10/01/2015 |
| L35631 |
MolDX: Breast Cancer Index℠ Genetic Assay-Palmetto GBA |
10/01/2015 |
| L35632 |
MolDX-CDD: ConfirmMDx Epigenetic Molecular Assay-Palmetto GBA |
10/01/2015 |
| L35633 |
MolDX: GeneSight® Assay for Refractory Depression-Palmetto GBA |
10/01/2015 |
| L35658 |
Surgery: Implantable Hormone Pellets-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L35660 |
Pathology and Laboratory: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L35677 |
Infliximab (Remicade®)-Palmetto GBA |
10/01/2015 |
| L35679 |
Pharmacokinetic (PK) Testing for Chemotherapy Dosing-Novitas Solutions, Inc. |
10/01/2015 |
| L35698 |
CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing-First Coast Service Options, Inc. |
10/01/2015 |
| L35702 |
Mohs Micrographic Surgery-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L35704 |
Mohs Micrographic Surgery-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L35710 |
Circulating Tumor Cell Marker Assays-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L35724 |
Controlled Substance Monitoring and Drugs of Abuse Testing-Palmetto GBA |
10/01/2015 |
| L35751 |
Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L35753 |
Non-Invasive Cerebrovascular Studies-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L35755 |
Non-Invasive Abdominal / Visceral Vascular Studies-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L35761 |
Non-Invasive Peripheral Arterial Vascular Studies-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L35868 |
MolDX-CDD: Decipher® Prostate Cancer Classifier Assay-Palmetto GBA |
10/01/2015 |
| L35869 |
MolDX-CDD: Prolaris™ Prostate Cancer Genomic Assay-Palmetto GBA |
10/01/2015 |
| L35878 |
Infectious Disease Molecular Diagnostic Testing-CGS Administrators, LLC |
10/01/2015 |
| L35889 |
Surgery: Left Atrial Appendage-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L35891 |
Intravenous Immune Globulin-CGS Administrators, LLC |
10/01/2015 |
| L35897 |
Nerve Conduction Studies and Electromyography-CGS Administrators, LLC |
10/01/2015 |
| L35906 |
Somatosensory Testing-CGS Administrators, LLC |
10/01/2015 |
| L35920 |
Pathology and Laboratory: Quantitative Drug Testing-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L35922 |
Special Histochemical Stains and Immunohistochemical Stains-Palmetto GBA |
10/01/2015 |
| L35936 |
Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy-National Government Services, Inc. |
10/01/2015 |
| L35937 |
Lumbar Epidural Injections-National Government Services, Inc. |
10/01/2015 |
| L35941 |
Medicine: Psychotherapy Services-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L35942 |
Surgery: Fusion for Degenerative Joint Disease of the Lumbar Spine-Cahaba Government Benefit Administrators®, LLC |
10/01/2015 |
| L35974 |
MolDX: MGMT Promoter Methylation Analysis-Palmetto GBA |
10/01/2015 |
| L35984 |
MolDX: Genetic Testing for Hypercoagulability / Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR)-CGS Administrators, LLC |
10/01/2015 |
| L35986 |
Special Histochemical Stains and Immunohistochemical Stains-CGS Administrators, LLC |
10/01/2015 |
| L35996 |
Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L35998 |
Non-Coronary Vascular Stents-Wisconsin Physicians Service Insurance Corporation |
10/01/2015 |
| L36007 |
Lower Extremity Major Joint Replacement (Hip and Knee)-Novitas Solutions, Inc. |
10/01/2015 |
| L36021 |
Molecular Diagnostic Tests (MDT)-CGS Administrators, LLC |
10/01/2015 |
| L36035 |
Spinal Cord Stimulation for Chronic Pain-First Coast Service Options, Inc. |
10/01/2015 |
| L36074 |
MolDX: Molecular RBC Phenotyping-Palmetto GBA |
10/01/2015 |
| L36089 |
MolDX: Genetic Testing for Hypercoagulability / Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR)-Palmetto GBA |
10/01/2015 |
| L36094 |
Flow Cytometry-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L36109 |
Minimally Invasive Treatment for Benign Prostatic Hyperplasia Involving Prostatic Urethral Lift (Urolift®)-Palmetto GBA |
10/01/2015 |
| L36125 |
MolDX: Breast Cancer Assay: Prosigna -Palmetto GBA |
10/01/2015 |
| L36143 |
MolDX-CDD: NSCLC, Comprehensive Genomic Profile Testing-Palmetto GBA |
10/01/2015 |
| L36153 |
MolDX-CDD: Genomic Health™ Oncotype DX® Prostate Cancer Assay-Palmetto GBA |
10/01/2015 |
| L36174 |
MolDX-CDD: NSCLC, Comprehensive Genomic Profile Testing-CGS Administrators, LLC |
10/01/2015 |
| L36209 |
Cardiology – non-emergent outpatient testing: exercise stress test, stress echo, MPI SPECT, and cardiac PET-First Coast Service Options, Inc. |
10/01/2015 |
| L36219 |
Non Covered Services-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L36236 |
Autonomic Function Testing-National Government Services, Inc. |
10/01/2015 |
| L36237 |
Amniotic Membrane- Sutureless Placement on the Ocular Surface -First Coast Service Options, Inc. |
10/01/2015 |
| L36238 |
Humanitarian Use Device (HUD) and Humanitarian Device Exemption (HDE) process-First Coast Service Options, Inc. |
10/01/2015 |
| L36240 |
Allergen Immunotherapy -Novitas Solutions, Inc. |
10/01/2015 |
| L36241 |
Allergy Testing-Novitas Solutions, Inc. |
10/01/2015 |
| L36256 |
MolDX: Molecular Diagnostic Tests (MDT)-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L36276 |
Erythropoiesis Stimulating Agents -First Coast Service Options, Inc. |
10/01/2015 |
| L36286 |
Blepharoplasty, Eyelid Surgery, and Brow Lift-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L36296 |
Sacral Neuromodulation-First Coast Service Options, Inc. |
10/01/2015 |
| L36310 |
MolDX: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L36312 |
MolDX: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L36313 |
MolDX: Breast Cancer Index℠ Genetic Assay-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L36314 |
MolDX: Breast Cancer Index℠ Genetic Assay-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L36316 |
MolDX: Breast Cancer Index℠ Genetic Assay-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L36321 |
MolDX: Breast Cancer Index℠ Genetic Assay-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L36322 |
MolDX: GeneSight® Assay for Refractory Depression-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L36323 |
MolDX: GeneSight® Assay for Refractory Depression-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L36324 |
MolDX: GeneSight® Assay for Refractory Depression-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L36325 |
MolDX: GeneSight® Assay for Refractory Depression-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L36326 |
MolDX-CDD: ConfirmMDx Epigenetic Molecular Assay-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L36327 |
MolDX-CDD: ConfirmMDx Epigenetic Molecular Assay-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L36328 |
MolDX-CDD: ConfirmMDx Epigenetic Molecular Assay-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L36329 |
MolDX-CDD: ConfirmMDx Epigenetic Molecular Assay-Noridian Healthcare Solutions, LLC |
10/01/2015 |
| L36342 |
Screening and Diagnostic Mammography-First Coast Service Options, Inc. |
10/01/2015 |
| L36355 |
Colorectal Cancer Screening-First Coast Service Options, Inc. |
10/01/2015 |
| L36356 |
Bone Mineral Density Studies-First Coast Service Options, Inc. |
10/01/2015 |
| L36377 |
Application of Skin Substitute Grafts for Treatment of DFU and VLU of Lower Extremities-First Coast Service Options, Inc. |
10/01/2015 |
| L36002 |
MolDX-CDD: Prolaris™ Prostate Cancer Genomic Assay-CGS Administrators, LLC |
10/05/2015 |
| L36006 |
MolDX-CDD: ConfirmMDx Epigenetic Molecular Assay-CGS Administrators, LLC |
10/05/2015 |
| L36011 |
MolDX: Molecular RBC Phenotyping-CGS Administrators, LLC |
10/05/2015 |
| L36029 |
Controlled Substance Monitoring and Drugs of Abuse Testing-CGS Administrators, LLC |
10/05/2015 |
| L36033 |
MolDX: HLA-B*15:02 Genetic Testing-Palmetto GBA |
10/05/2015 |
| L36044 |
MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease-Palmetto GBA |
10/05/2015 |
| L36048 |
MolDX: HLA-B*15:02 Genetic Testing-CGS Administrators, LLC |
10/05/2015 |
| L36082 |
MolDX: BRCA1 and BRCA2 Genetic Testing-Palmetto GBA |
10/05/2015 |
| L36113 |
MolDX: MGMT Promoter Methylation Analysis-CGS Administrators, LLC |
10/05/2015 |
| L36117 |
MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease-CGS Administrators, LLC |
10/05/2015 |
| L36129 |
MolDX: Biomarkers in Cardiovascular Risk Assessment-Palmetto GBA |
10/05/2015 |
| L36139 |
MolDX: Biomarkers in Cardiovascular Risk Assessment-CGS Administrators, LLC |
10/05/2015 |
| L36206 |
MolDX-CDD: Genomic Health™ Oncotype DX® Prostate Cancer Assay-CGS Administrators, LLC |
10/05/2015 |
| L36393 |
Controlled Substance Monitoring and Drugs of Abuse Testing-First Coast Service Options, Inc. |
10/11/2015 |
| L36340 |
MolDX-CDD: Prolaris™ Prostate Cancer Genomic Assay-Noridian Healthcare Solutions, LLC |
10/15/2015 |
| L36341 |
MolDX-CDD: Decipher® Prostate Cancer Classifier Assay-Noridian Healthcare Solutions, LLC |
10/15/2015 |
| L36343 |
MolDX-CDD: Decipher® Prostate Cancer Classifier Assay-Noridian Healthcare Solutions, LLC |
10/15/2015 |
| L36344 |
MolDX-CDD: Decipher® Prostate Cancer Classifier Assay-Noridian Healthcare Solutions, LLC |
10/15/2015 |
| L36345 |
MolDX-CDD: Decipher® Prostate Cancer Classifier Assay-Noridian Healthcare Solutions, LLC |
10/15/2015 |
| L36346 |
Special Histochemical Stains and Immunohistochemical Stains-Noridian Healthcare Solutions, LLC |
10/15/2015 |
| L36348 |
MolDX-CDD: Prolaris™ Prostate Cancer Genomic Assay-Noridian Healthcare Solutions, LLC |
10/15/2015 |
| L36349 |
MolDX-CDD: Prolaris™ Prostate Cancer Genomic Assay-Noridian Healthcare Solutions, LLC |
10/15/2015 |
| L36350 |
MolDX-CDD: Prolaris™ Prostate Cancer Genomic Assay-Noridian Healthcare Solutions, LLC |
10/15/2015 |
| L36351 |
Special Histochemical Stains and Immunohistochemical Stains-Noridian Healthcare Solutions, LLC |
10/15/2015 |
| L36352 |
Special Histochemical Stains and Immunohistochemical Stains-Noridian Healthcare Solutions, LLC |
10/15/2015 |
| L36353 |
Special Histochemical Stains and Immunohistochemical Stains-Noridian Healthcare Solutions, LLC |
10/15/2015 |
| L36409 |
Immune Globulin Intravenous (IVIg)-Noridian Healthcare Solutions, LLC |
11/07/2015 |
| L36230 |
Evaluation and Management Services in a Nursing Facility -First Coast Service Options, Inc. |
11/15/2015 |
| L36232 |
Diagnostic Evaluation and Medical Management of Moderate-Severe Dry Eye Disease (DED)-First Coast Service Options, Inc. |
11/22/2015 |
| L34265 |
Medicine: Nerve Conduction Studies (NCS) and Electromyography (EMG)-Cahaba Government Benefit Administrators®, LLC |
12/01/2015 |
| L36037 |
Urine Drug Testing-National Government Services, Inc. |
12/01/2015 |
| L36039 |
Total Joint Arthroplasty-National Government Services, Inc. |
12/01/2015 |
| L36084 |
Surgery: Leadless Cardiac Pacemaker-Cahaba Government Benefit Administrators®, LLC |
12/01/2015 |
| L36086 |
Radiology: Intra-vascular Optical Coherence Tomography-Cahaba Government Benefit Administrators®, LLC |
12/01/2015 |
| L36267 |
Bowel Management Devices-Noridian Administrative Services |
12/01/2015 |
| L36234 |
Special Histochemical Stains & Immunohistochemical Stains -First Coast Service Options, Inc. |
12/06/2015 |
| L36000 |
Percutaneous minimally invasive fusion/stabilization of the sacroiliac joint for the treatment of back pain-Wisconsin Physicians Service Insurance Corporation |
12/17/2015 |
| L36427 |
Wireless Capsule Endoscopy-Palmetto GBA |
01/25/2016 |
| L36425 |
MolDX: Breast Cancer Assay: Prosigna -CGS Administrators, LLC |
02/01/2016 |
| L36458 |
MolDX: Breast Cancer Index℠ Genetic Assay-CGS Administrators, LLC |
02/01/2016 |
| L36460 |
Bone Mass Measurement-CGS Administrators, LLC |
02/01/2016 |
| L36483 |
MolDX: Chromosome 1p/19q Deletion Analysis-Palmetto GBA |
02/01/2016 |
| L36487 |
MolDX: Chromosome 1p/19q deletion analysis-CGS Administrators, LLC |
02/01/2016 |
| L36494 |
Minimally-Invasive Surgical (MIS) Fusion of the Sacroiliac (SI) Joint-CGS Administrators, LLC |
02/01/2016 |
| L36469 |
Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder-CGS Administrators, LLC |
02/08/2016 |
| L36456 |
MolDX: BRCA1 and BRCA2 Genetic Testing-CGS Administrators, LLC |
02/15/2016 |
| L36464 |
MolDX: HLA-DQB1*06:02 Testing for Narcolepsy-Palmetto GBA |
02/15/2016 |
| L36471 |
Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy-Palmetto GBA |
02/15/2016 |
| L36485 |
MolDX: HLA-DQB1*06:02 Testing for Narcolepsy-CGS Administrators, LLC |
02/15/2016 |
| L36404 |
Foot Care-Wisconsin Physicians Service Insurance Corporation |
02/16/2016 |
| L36402 |
Allergy Testing -Wisconsin Physicians Service Insurance Corporation |
03/18/2016 |
| L36408 |
Allergy Immunotherapy-Wisconsin Physicians Service Insurance Corporation |
03/18/2016 |
| L36145 |
MolDX: HLA-B*15:02 Genetic Testing-Noridian Healthcare Solutions, LLC |
04/01/2016 |
| L36149 |
MolDX: HLA-B*15:02 Genetic Testing-Noridian Healthcare Solutions, LLC |
04/01/2016 |
| L36167 |
MolDX: Molecular RBC Phenotyping-Noridian Healthcare Solutions, LLC |
04/01/2016 |
| L36171 |
MolDX: Molecular RBC Phenotyping-Noridian Healthcare Solutions, LLC |
04/01/2016 |
| L36376 |
Genomic Sequence Analysis Panels in the Treatment of Non-Small Cell Lung Cancer-National Government Services, Inc. |
04/01/2016 |
| L36406 |
Minimally-invasive Surgical (MIS) Fusion of the Sacroiliac (SI) Joint-National Government Services, Inc. |
04/01/2016 |
| L36444 |
Pathology and Laboratory: Molecular RBC Phenotype-Cahaba Government Benefit Administrators®, LLC |
04/01/2016 |
| L36446 |
Pathology and Laboratory: Partial Genome Profiling in Non Small Cell Lung Cancer (NSCLC)-Cahaba Government Benefit Administrators®, LLC |
04/01/2016 |
| L36419 |
Outpatient Wireless Pulmonary Artery Pressure Monitoring for Heart Failure -Novitas Solutions, Inc. |
04/07/2016 |
| L36423 |
Strapping-Novitas Solutions, Inc. |
04/07/2016 |
| L36434 |
Microvascular Therapy-Novitas Solutions, Inc. |
04/07/2016 |
| L36499 |
BRCA1 and BRCA2 Genetic Testing-First Coast Service Options, Inc. |
04/11/2016 |
| L36504 |
Hyperbaric Oxygen (HBO) Therapy -First Coast Service Options, Inc. |
04/11/2016 |
| L36634 |
In Vitro Chemosensitivity & Chemoresistance Assays -Novitas Solutions, Inc. |
04/11/2016 |
| L36161 |
MolDX: BRCA1 and BRCA2 Genetic Testing-Noridian Healthcare Solutions, LLC |
04/15/2016 |
| L36163 |
MolDX: BRCA1 and BRCA2 Genetic Testing-Noridian Healthcare Solutions, LLC |
04/15/2016 |
| L36188 |
MolDX: MGMT Promoter Methylation Analysis-Noridian Healthcare Solutions, LLC |
04/15/2016 |
| L36192 |
MolDX: MGMT Promoter Methylation Analysis-Noridian Healthcare Solutions, LLC |
04/15/2016 |
| L36194 |
MolDX-CDD: NSCLC, Comprehensive Genomic Profile Testing-Noridian Healthcare Solutions, LLC |
04/15/2016 |
| L36198 |
MolDX- CDD: NSCLC, Comprehensive Genomic Profile Testing-Noridian Healthcare Solutions, LLC |
04/15/2016 |
| L36398 |
MolDX: Genetic Testing for CYP2C19, CYP2D6, CYP2C9, and VKORC1 -Wisconsin Physicians Service Insurance Corporation |
04/16/2016 |
| L36400 |
MolDX: Genetic Testing for Hypercoagulability/Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR)-Wisconsin Physicians Service Insurance Corporation |
04/16/2016 |
| L36180 |
MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease-Noridian Healthcare Solutions, LLC |
04/19/2016 |
| L36186 |
MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease-Noridian Healthcare Solutions, LLC |
04/19/2016 |
| L36380 |
MolDX: Breast Cancer Assay: Prosigna -Noridian Healthcare Solutions, LLC |
05/03/2016 |
| L36386 |
MolDX: Breast Cancer Assay: Prosigna -Noridian Healthcare Solutions, LLC |
05/03/2016 |
| L36466 |
Application of Skin Substitutes-Palmetto GBA |
05/17/2016 |
| L36204 |
Spinal Cord Stimulators for Chronic Pain-Noridian Healthcare Solutions, LLC |
06/01/2016 |
| L36358 |
MolDX: Biomarkers in Cardiovascular Risk Assessment-Noridian Healthcare Solutions, LLC |
06/01/2016 |
| L36362 |
MolDX: Biomarkers in Cardiovascular Risk Assessment-Noridian Healthcare Solutions, LLC |
06/01/2016 |
| L36370 |
MolDX: Genetic Testing for Lynch Syndrome-Noridian Healthcare Solutions, LLC |
06/01/2016 |
| L36374 |
MolDX: Genetic Testing for Lynch Syndrome-Noridian Healthcare Solutions, LLC |
06/01/2016 |
| L36524 |
Nerve Conduction Studies and Electromyography-Noridian Healthcare Solutions, LLC |
06/01/2016 |
| L36526 |
Nerve Conduction Studies and Electromyography-Noridian Healthcare Solutions, LLC |
06/01/2016 |
| L36593 |
Polysomnography-Palmetto GBA |
06/13/2016 |
| L36155 |
MolDX: Genetic Testing for Hypercoagulability / Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR)-Noridian Healthcare Solutions, LLC |
06/16/2016 |
| L36159 |
MolDX: Genetic Testing for Hypercoagulability / Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR)-Noridian Healthcare Solutions, LLC |
06/16/2016 |
| L36521 |
Lumbar Epidural Injections-Wisconsin Physicians Service Insurance Corporation |
06/16/2016 |
| L36523 |
MolDX: Biomarkers in Cardiovascular Risk Assessment-Wisconsin Physicians Service Insurance Corporation |
06/16/2016 |
| L36668 |
Controlled Substance Monitoring and Drugs of Abuse Testing-Noridian Healthcare Solutions, LLC |
06/28/2016 |
| L36707 |
Controlled Substance Monitoring and Drugs of Abuse Testing-Noridian Healthcare Solutions, LLC |
06/28/2016 |
| L36601 |
Prostatic Urethral Lift (PUL)-National Government Services, Inc. |
07/01/2016 |
| L36335 |
MolDX: NRAS Genetic Testing-Noridian Healthcare Solutions, LLC |
07/05/2016 |
| L36339 |
MolDX: NRAS Genetic Testing-Noridian Healthcare Solutions, LLC |
07/05/2016 |
| L36364 |
MolDX-CDD: Genomic Health™ Oncotype DX® Prostate Cancer Assay-Noridian Healthcare Solutions, LLC |
07/05/2016 |
| L36368 |
MolDX-CDD: Genomic Health™ Oncotype DX® Prostate Cancer Assay-Noridian Healthcare Solutions, LLC |
07/05/2016 |
| L36538 |
Treatment of Males with Low Testosterone-Noridian Healthcare Solutions, LLC |
07/12/2016 |
| L36569 |
Treatment of Males with Low Testosterone-Noridian Healthcare Solutions, LLC |
07/12/2016 |
| L36542 |
MolDX: Chromosome 1p/19q Deletion Analysis-Noridian Healthcare Solutions, LLC |
08/01/2016 |
| L36557 |
MolDX: Chromosome 1p/19q Deletion Analysis-Noridian Healthcare Solutions, LLC |
08/01/2016 |
| L36582 |
Pathology and Laboratory: K-ras Testing prior to Treatment of Colorectal Cancer (CRC)-Cahaba Government Benefit Administrators®, LLC |
08/01/2016 |
| L36573 |
Total Hip Arthroplasty-Noridian Healthcare Solutions, LLC |
09/07/2016 |
| L36575 |
Total Knee Arthroplasty-Noridian Healthcare Solutions, LLC |
09/07/2016 |
| L36577 |
Total Knee Arthroplasty-Noridian Healthcare Solutions, LLC |
09/07/2016 |
| L36617 |
Chiropractic Services-First Coast Service Options, Inc. |
09/12/2016 |
| L36544 |
MolDX: HLA-DQB1*06:02 Testing for Narcolepsy-Noridian Healthcare Solutions, LLC |
09/15/2016 |
| L36551 |
MolDX: HLA-DQB1*06:02 Testing for Narcolepsy-Noridian Healthcare Solutions, LLC |
09/15/2016 |
| L36741 |
Pathology and Laboratory: BRCA1 and BRCA2 Genetic Testing-Cahaba Government Benefit Administrators®, LLC |
10/01/2016 |
| L36743 |
Radiology: Intensity Modulated Radiation Therapy (IMRT)-Cahaba Government Benefit Administrators®, LLC |
10/01/2016 |
| L36745 |
Medicine: Home Sleep Testing (HST)-Cahaba Government Benefit Administrators®, LLC |
10/01/2016 |
| L36598 |
White Cell Colony Stimulating Factors-Palmetto GBA |
10/10/2016 |
| L36656 |
MolDX-CDD: Decipher® Prostate Cancer Classifier Assay-CGS Administrators, LLC |
10/10/2016 |
| L36665 |
MolDX- CDD: ProMark Risk Score-Palmetto GBA |
10/10/2016 |
| L36675 |
MolDX- CDD: ProMark Risk Score-CGS Administrators, LLC |
10/10/2016 |
| L36690 |
Wound Application of Cellular and/or Tissue Based Products (CTPs), Lower Extremities-CGS Administrators, LLC |
10/10/2016 |
| L36761 |
GlycoMark Testing for Glycemic Control-Palmetto GBA |
10/17/2016 |
| L36658 |
Proton Beam Therapy-CGS Administrators, LLC |
10/24/2016 |
| L36767 |
Aortography and peripheral angiography-First Coast Service Options, Inc. |
10/31/2016 |
| L36775 |
Prostatic Urethral Lift (PUL)-First Coast Service Options, Inc. |
10/31/2016 |
| L36749 |
Air Ambulance Services-National Government Services, Inc. |
11/01/2016 |
| L36773 |
Intensity Modulated Radiation Therapy (IMRT) -First Coast Service Options, Inc. |
11/07/2016 |
| L36763 |
MolDX: 4Kscore Assay-Palmetto GBA |
11/21/2016 |
| L36711 |
Intensity Modulated Radiation Therapy (IMRT)-Novitas Solutions, Inc. |
12/01/2016 |
| L36713 |
Corus® CAD Test-Novitas Solutions, Inc. |
12/01/2016 |
| L36715 |
BRCA1 and BRCA2 Genetic Testing-Novitas Solutions, Inc. |
12/01/2016 |
| L36926 |
Genomic Sequence Analysis Panels in the Treatment of Acute Myelogenous Leukemia (AML)-National Government Services, Inc. |
02/01/2017 |
| L36692 |
Vitamin D Assay Testing-Noridian Healthcare Solutions, LLC |
02/03/2017 |
| L36785 |
MolDX: Breast Cancer Index℠ Genetic Assay-Wisconsin Physicians Service Insurance Corporation |
02/16/2017 |
| L36787 |
MolDX-CDD: Prolaris™ Prostate Cancer Genomic Assay -Wisconsin Physicians Service Insurance Corporation |
02/16/2017 |
| L36789 |
MolDX-CDD: Genomic Health™ Oncotype DX® Prostate Cancer Assay-Wisconsin Physicians Service Insurance Corporation |
02/16/2017 |
| L36791 |
MolDX-CDD: Decipher® Prostate Cancer Classifier Assay -Wisconsin Physicians Service Insurance Corporation |
02/16/2017 |
| L36793 |
MolDX: Genetic Testing for Lynch Syndrome-Wisconsin Physicians Service Insurance Corporation |
02/16/2017 |
| L36795 |
MolDX: Molecular RBC Phenotyping-Wisconsin Physicians Service Insurance Corporation |
02/16/2017 |
| L36797 |
MolDX: NRAS Genetic Testing-Wisconsin Physicians Service Insurance Corporation |
02/16/2017 |
| L36799 |
MolDX: GeneSight® Assay for Refractory Depression-Wisconsin Physicians Service Insurance Corporation |
02/16/2017 |
| L36801 |
MolDX: HLA-B*15:02 Genetic Testing-Wisconsin Physicians Service Insurance Corporation |
02/16/2017 |
| L36803 |
MolDX-CDD: NSCLC, Comprehensive Genomic Profile Testing-Wisconsin Physicians Service Insurance Corporation |
02/16/2017 |
| L36805 |
Special Histochemical Stains and Immunohistochemical Stains-Wisconsin Physicians Service Insurance Corporation |
02/16/2017 |
| L36807 |
MolDX: Molecular Diagnostic Tests (MDT)-Wisconsin Physicians Service Insurance Corporation |
02/16/2017 |
| L36811 |
MolDX: Breast Cancer Assay: Prosigna-Wisconsin Physicians Service Insurance Corporation |
02/16/2017 |
| L36813 |
MolDX: BRCA1 and BRCA2 Genetic Testing-Wisconsin Physicians Service Insurance Corporation |
02/16/2017 |
| L36815 |
MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease-Wisconsin Physicians Service Insurance Corporation |
02/16/2017 |
| L36839 |
Polysomnography and Other Sleep Studies-Wisconsin Physicians Service Insurance Corporation |
02/16/2017 |
| L36879 |
Surgery: Spinal Cord Stimulators for Chronic Pain-Cahaba Government Benefit Administrators®, LLC |
03/01/2017 |
| L36945 |
Medicine: Bioimpedance Spectroscopy (BIS) Devices for the Detection and Management of Lymphedema-Cahaba Government Benefit Administrators®, LLC |
03/01/2017 |
| L36902 |
Polysomnography and Other Sleep Studies-CGS Administrators, LLC |
03/06/2017 |
| L36906 |
GlycoMark Testing for Glycemic Control-CGS Administrators, LLC |
03/06/2017 |
| L36912 |
MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health™)-Palmetto GBA |
03/06/2017 |
| L36951 |
MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health™) -CGS Administrators, LLC |
03/06/2017 |
| L36973 |
MolDX: Circulating Tumor Cell Marker Assays-CGS Administrators, LLC |
03/06/2017 |
| L36975 |
Bladder/Urothelial Tumor Markers-CGS Administrators, LLC |
03/06/2017 |
| L36700 |
Serum Magnesium-Noridian Healthcare Solutions, LLC |
03/13/2017 |
| L36702 |
Serum Magnesium-Noridian Healthcare Solutions, LLC |
03/13/2017 |
| L36827 |
MolDX: APC and MUTYH Gene Testing -Palmetto GBA |
03/13/2017 |
| L36854 |
MolDX: Percepta© Bronchial Genomic Classifier-Palmetto GBA |
03/13/2017 |
| L36908 |
MolDX: Percepta© Bronchial Genomic Classifier-CGS Administrators, LLC |
03/13/2017 |
| L36910 |
MolDX: APC and MUTYH Gene Testing -CGS Administrators, LLC |
03/13/2017 |
| L36979 |
MolDX: 4Kscore Assay-CGS Administrators, LLC |
03/13/2017 |
| L36831 |
Visual Electrophysiology Testing -National Government Services, Inc. |
03/16/2017 |
| L36941 |
MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health™)-Noridian Healthcare Solutions, LLC |
03/27/2017 |
| L36947 |
MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health™)-Noridian Healthcare Solutions, LLC |
03/27/2017 |
| L36850 |
Peripheral Nerve Blocks-National Government Services, Inc. |
05/01/2017 |
| L36920 |
Epidural Injections for Pain Management -Novitas Solutions, Inc. |
05/04/2017 |
| L36882 |
MolDX: APC and MUTYH Gene Testing -Noridian Healthcare Solutions, LLC |
05/15/2017 |
| L36884 |
MolDX: APC and MUTYH Gene Testing -Noridian Healthcare Solutions, LLC |
05/15/2017 |
| L36886 |
MolDX: Percepta© Bronchial Genomic Classifier-Noridian Healthcare Solutions, LLC |
05/15/2017 |
| L36891 |
MolDX: Percepta© Bronchial Genomic Classifier-Noridian Healthcare Solutions, LLC |
05/15/2017 |
| L36678 |
Bladder/Urothelial Tumor Markers-Noridian Healthcare Solutions, LLC |
05/16/2017 |
| L36680 |
Bladder/Urothelial Tumor Markers-Noridian Healthcare Solutions, LLC |
05/16/2017 |
| L36859 |
Trigger Point Injections-Noridian Healthcare Solutions, LLC |
05/26/2017 |
| L36704 |
MolDX- CDD: ProMark Risk Score-Noridian Healthcare Solutions, LLC |
06/01/2017 |
| L36706 |
MolDX-CDD: ProMark Risk Score-Noridian Healthcare Solutions, LLC |
06/01/2017 |
| L36861 |
Polysomnography and Other Sleep Studies-Noridian Healthcare Solutions, LLC |
06/05/2017 |
| L36954 |
Noncovered Services other than CPT® Category III Noncovered Services-Palmetto GBA |
06/05/2017 |
| L37176 |
White Cell Colony Stimulating Factors-Palmetto GBA |
06/12/2017 |
| L37022 |
Coenzyme Q10 (CoQ10)-Palmetto GBA |
07/10/2017 |
| L37031 |
MolDX: Xpresys Lung -Palmetto GBA |
07/10/2017 |
| L37033 |
MolDX: DecisionDx-UM (Uveal Melanoma)-Palmetto GBA |
07/10/2017 |
| L37035 |
MolDX: Vita Risk™ Pharmacogenetic Test for Dry Age-related Macular Degeneration (AMD)-Palmetto GBA |
07/10/2017 |
| L37043 |
MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease-Palmetto GBA |
07/10/2017 |
| L37126 |
Coenzyme Q10 (CoQ10)-CGS Administrators, LLC |
07/10/2017 |
| L37130 |
MolDX: DecisionDx-UM (Uveal Melanoma)-CGS Administrators, LLC |
07/10/2017 |
| L37134 |
MolDX: Xpresys Lung -CGS Administrators, LLC |
07/10/2017 |
| L37140 |
MolDX: Vita Risk™ Pharmacogenetic Test for Dry Age-related Macular Degeneration (AMD)-CGS Administrators, LLC |
07/10/2017 |
| L37142 |
MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease-CGS Administrators, LLC |
07/10/2017 |
| L36868 |
Diagnostic and Therapeutic Colonoscopy -Noridian Healthcare Solutions, LLC |
07/17/2017 |
| L36889 |
Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography-Noridian Healthcare Solutions, LLC |
07/17/2017 |
| L37001 |
MolDX: MGMT Promoter Methylation Analysis-Wisconsin Physicians Service Insurance Corporation |
07/17/2017 |
| L37003 |
MolDX: HLA-DQB1*06:02 Testing for Narcolepsy-Wisconsin Physicians Service Insurance Corporation |
07/17/2017 |
| L37005 |
MolDX-CDD: ConfirmMDx Epigenetic Molecular Assay-Wisconsin Physicians Service Insurance Corporation |
07/17/2017 |
| L37009 |
MolDX: Chromosome 1p/19q Deletion Analysis-Wisconsin Physicians Service Insurance Corporation |
07/17/2017 |
| L37011 |
MolDX-CDD: ProMark Risk Score-Wisconsin Physicians Service Insurance Corporation |
07/17/2017 |
| L37013 |
MolDX: 4Kscore Assay-Wisconsin Physicians Service Insurance Corporation |
07/17/2017 |
| L37015 |
Visual Electrophysiology Testing-Wisconsin Physicians Service Insurance Corporation |
07/17/2017 |
| L36846 |
Measurement of Salivary Hormones-Noridian Healthcare Solutions, LLC |
07/21/2017 |
| L36857 |
Measurement of Salivary Hormones-Noridian Healthcare Solutions, LLC |
07/21/2017 |
| L36962 |
Vascular Endothelial Growth Factor Inhibitors for the Treatment of Ophthalmological Diseases -First Coast Service Options, Inc. |
07/24/2017 |
| L36864 |
GlycoMark Testing for Glycemic Control-Noridian Healthcare Solutions, LLC |
08/01/2017 |
| L36866 |
GlycoMark Testing for Glycemic Control-Noridian Healthcare Solutions, LLC |
08/01/2017 |
| L37195 |
MolDX: Percepta© Bronchial Genomic Classifier-Wisconsin Physicians Service Insurance Corporation |
09/16/2017 |
| L37199 |
MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health™)-Wisconsin Physicians Service Insurance Corporation |
09/16/2017 |
| L37205 |
Chemotherapy Drugs and their Adjuncts-Wisconsin Physicians Service Insurance Corporation |
09/16/2017 |
| L37210 |
MolDX: Decision Dx-UM (Uveal Melanoma)-Wisconsin Physicians Service Insurance Corporation |
09/16/2017 |
| L37216 |
MolDX: Xpresys Lung-Wisconsin Physicians Service Insurance Corporation |
09/16/2017 |
| L37224 |
MolDX: APC and MUTYH Gene Testing-Wisconsin Physicians Service Insurance Corporation |
09/16/2017 |
| L37226 |
MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease-Wisconsin Physicians Service Insurance Corporation |
09/16/2017 |
| L37379 |
Echocardiography -Palmetto GBA |
09/18/2017 |
| L37070 |
MolDX: DecisionDx-UM (Uveal Melanoma)-Noridian Healthcare Solutions, LLC |
09/22/2017 |
| L37072 |
MolDX: DecisionDx-UM (Uveal Melanoma)-Noridian Healthcare Solutions, LLC |
09/22/2017 |
| L37080 |
MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease-Noridian Healthcare Solutions, LLC |
09/25/2017 |
| L37082 |
MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease-Noridian Healthcare Solutions, LLC |
09/25/2017 |
| L37387 |
Chiropractic Services-Palmetto GBA |
09/25/2017 |
| L37260 |
MolDX: Prometheus IBD sgi Diagnostic Policy-Palmetto GBA |
09/26/2017 |
| L37054 |
MolDX: Xpresys Lung -Noridian Healthcare Solutions, LLC |
09/29/2017 |
| L37062 |
MolDX: Xpresys Lung -Noridian Healthcare Solutions, LLC |
09/29/2017 |
| L37066 |
Coenzyme Q10 (CoQ10)-Noridian Healthcare Solutions, LLC |
10/02/2017 |
| L37068 |
Coenzyme Q10 (CoQ10)-Noridian Healthcare Solutions, LLC |
10/02/2017 |
| L37262 |
MolDX: Oncotype DX® Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer-Palmetto GBA |
10/02/2017 |
| L37264 |
MolDX: EndoPredict Breast Cancer Gene Expression Test-Palmetto GBA |
10/02/2017 |
| L37266 |
MolDX: AlloSure® Donor-Derived Cell-Free DNA Test-Palmetto GBA |
10/02/2017 |
| L37020 |
Plastic Surgery-Noridian Healthcare Solutions, LLC |
10/10/2017 |
| L37027 |
Cataract Surgery in Adults-Noridian Healthcare Solutions, LLC |
10/10/2017 |
| L37193 |
Coenzyme Q10 Testing-Wisconsin Physicians Service Insurance Corporation |
10/17/2017 |
| L37254 |
Chiropractic Services-CGS Administrators, LLC |
11/06/2017 |
| L37352 |
MolDX: Prometheus IBD sgi Diagnostic Policy-CGS Administrators, LLC |
11/06/2017 |
| L37166 |
Wound Care-First Coast Service Options, Inc. |
11/09/2017 |
