New Carrier-Priced (C Status) Procedures for 2007
T-code services will be reviewed individually. Under most circumstances, details for T-codes (category III) will be denied as experimental/investigative and, therefore, not medically necessary. Please see related article entitled T-Codes (Category III) in the December 2005 (pages 15-16) Communiqué which explains the purpose and significance of these codes.
For the other C status codes listed below (other than the T-codes) there are no CMS established fees and they will be reviewed on an individual consideration. Typically, we will establish a price for these services. However, we normally do not price them until they have been billed. WPS may request medical records to assist in the evaluation and pricing of these services, since often these are unlisted procedures. Some of the C status codes are very specific, but have not been priced by CMS. These typically reflect new technology.
Effective for dates of service January 1, 2007 and after, there are 20 new CPT codes, which have a status of "C" (carrier-priced) on the 2007 Medicare Physician Fee Schedule Database (MPFSDB) but do not have pricing established.
New 2007 C Status Codes:
0162T - Electronic analysis and programming, reprogramming of gastric neurostimulator (ie, morbid obesity)
0164T - Removal of total disc arthroplasty, anterior approach, lumbar, each additional interspace
0165T - Revision of total disc arthroplasty, anterior approach, lumbar, each additional interspace
0166T - Transmyocardial transcatheter closure of ventricular septal defect, with implant; without cardiopulmonary bypass
0167T - Transmyocardial transcatheter closure of ventricular septal defect, with implant; with cardiopulmonary bypass
0168T - Rhinophototherapy, intranasal application of ultraviolet and visible light, bilateral
0169T - Stereotactic placement of infusion catheter(s) in the brain for delivery of therapeutic agent(s), including computerized stereotactic planning and burr hole(s)
0170T - Repair of anorectal fistula with plug (eg, porcine small intestine submucosa sisù)
0173T - Monitoring of intraocular pressure during vitrectomy surgery (list separately in addition to code for primary procedure)
0174T - Computer aided detection (cad) (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation and report, with or without digitization of film radiographic images, chest radiograph(s), performed concurrent with primary interpretation use 0174t in conjunction with 71010, 71020, 71021, 71022, 71030)
0175T - Computer aided detection (cad) (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation and report, with or without digitization of film radiographic images, chest radiograph(s), performed remote from primary interpretation do not report 0175t in conjunction with 71010, 71020, 71021, 71022, 71030)
0176T - Transluminal dilation of aqueous outflow canal; without retention of device or stent
0177T - Transluminal dilation of aqueous outflow canal; with retention of device or stent
15847 - Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (list separately in addition to code for primary procedure)
70555 - (Global and TC Modifier) Magnetic resonance imaging, brain, functional mri; requiring physician or psychologist administration of entire neurofunctional testing
94774 - Pediatric home apnea monitoring event recording including respiratory rate, pattern and heart rate per 30-day period of time; includes monitor attachment, download of data, physician review, interpretation, and preparation of a report
94775 - Pediatric home apnea monitoring event recording including respiratory rate, pattern and heart rate per 30-day period of time; monitor attachment only (includes hook-up, initiation of recording and disconnection)
94776 - Pediatric home apnea monitoring event recording including respiratory rate, pattern and heart rate per 30-day period of time; monitoring, download of information, receipt of transmission(s) and analyses by computer only
94777 - Pediatric home apnea monitoring event recording including respiratory rate, pattern and heart rate per 30-day period of time; physician review, interpretation and preparation of report only
96020 - (Global and TC Modifier) Neurofunctional testing selection and administration during noninvasive imaging functional brain mapping, with test administered entirely by a physician or psychologist, with review of test results and report (changing from status A to status C)
Page Last Updated: Monday, 09-Jun-2008 13:34:14 CDT
