Notification

Musculoskeletal Services (AmeriHealth)


Notification Issue Date: 03/11/2020



Policy Attachment



Attachment to Policy # 00.01.66c


Attachment:B

Policy #:00.01.66c

Description:Procedure Codes for Joint 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: Joint Surgery Procedure Codes that require precertification/preapproval through AIM Specialty Health (AIM)

Shoulder Arthroplasty - (Total/Partial/Revision Shoulder Replacement)
23470
23472
23473
23474
Shoulder Arthroscopy and Open Procedures
23105
23107
23120
23130
23410
23412
23415
23420
23430
23440
23450
23455
23460
23462
23465
23466
23700
29805
29806
29807
29819
29820
29821
29822
29823
29824
29825
29826
29827
29828
Hip Arthroplasty - (Total/Partial/Revision Hip Replacement)
27120
27122
27125
27130
27132
27134
27137
27138
Hip Arthroscopy
29860
29861
29862
29863
29914
29915
29916
Knee Arthroplasty - (Total/Partial/Revision Knee Replacement)
27437
27438
27440
27441
27442
27443
27445
27446
27447
27486
27487
27488
Knee Arthroscopy and Open Procedures
27331
27332
27333
27334
27335
27403
27405
27407
27409
27427
27428
27429
29870
29871
29873
29874
29875
29876
29877
29879
29880
29881
29882
29883
29884
29885
29886
29887
29888
29889
G0289
Meniscal Allograft Transplantation of the Knee
29868
G0428
Treatment of Osteochondral Defects
27412
27415
27416
29866
29867
29879
28446
29892
J7330
S2112


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



2017 AmeriHealth.