Notification

Musculoskeletal Services (AmeriHealth)


Notification Issue Date: 03/11/2020



Policy Attachment



Attachment to Policy # 00.01.66c


Attachment:A

Policy #:00.01.66c

Description:Procedure Codes for Spinal Surgery

Title:Musculoskeletal Services (AmeriHealth)


Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.

Notification


Musculoskeletal Services: Spinal Surgery Procedure Codes that require precertification/preapproval through AIM Specialty Health® (AIM)

Cervical Decompression With or Without Fusion
0095T
22210
22216
22220
22226
22532
22548
22551
22552
22554
22556
22585
22590
22595
22600
22614
22632
22634
22830
22840
22841
22842
22843
22844
22845
22846
22847
22848
22849
22853
22854
22859
22864
63001
63003
63015
63016
63020
63035
63040
63043
63045
63046
63048
63050
63051
63055
63075
63076
63081
63082
63180
63182
63185
63190
63191
63194
63196
63198
63250
63265
63270
63275
63280
63285
63300
63304
63308
Cervical Disc Arthroplasty
0095T
0098T
0375T
22856
22858
22861
22864
Lumbar Disc Arthroplasty
0163T
0164T
0165T
22857
22862
22865
Lumbar Discectomy, Foraminotomy, and Laminotomy
63030
63035
63042
63044
63056
63057
Lumbar Fusion and Treatment of Spinal Deformity (including Scoliosis and Kyphosis)
0164T
22206
22207
22208
22212
22214
22216
22222
22224
22226
22533
22534
22558
22585
22610
22612
22614
22630
22632
22633
22634
22800
22802
22804
22808
22810
22812
22818
22819
22830
22840
22841
22842
22843
22844
22845
22846
22847
22848
22849
22853
22854
22859
22865
63085
63086
63087
63088
63090
63091
63101
63102
63103
63301
63302
63303
63305
63306
63307
63308
Lumbar Laminectomy
63005
63012
63017
63047
63048
63185
63190
63200
63252
63267
63272
63277
63282
63287
63290
Noninvasive Electrical Bone Growth Stimulation
20974
E0748
Vertebroplasty/Kyphoplasty
22510
22511
22512
22513
22514
22515
Bone Graft Substitutes and Bone Morphogenetic Proteins
20930
20931
20932
20933
20934
20936
20937
20938
20939
C9359
C9362



Version Effective Date: 06/15/2020
Version Issued Date: 06/15/2020
Version Reissued Date: N/A



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