Notification

Musculoskeletal Services (AmeriHealth)


Notification Issue Date: 03/11/2020



Policy Attachment



Attachment to Policy # 00.01.66c


Attachment:C

Policy #:00.01.66c

Description:Procedures Codes for Interventional Pain Management

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: Interventional Pain Management Procedure Codes that require precertification/preapproval through AIM Specialty Health® (AIM)
Epidural Injection Procedures and Diagnostic Selective Nerve Root Blocks
0228T
0229T
0230T
0231T
62320
62321
62322
62323
64479
64480
64483
64484
Paravertebral Facet Injection/Nerve Block/Neurolysis
0213T
0214T
0215T
0216T
0217T
0218T
64490
64491
64492
64493
64494
64495
64633
64634
64635
64636
64640
Regional Sympathetic Nerve Block
64510
64520
Sacroiliac Joint Injection
27096
G0260
Spinal Cord Stimulators
63650
63655
63663
63664
63685
63688
C1767
C1820
C1822
L8679
L8680
L8682
L8683
L8685
L8686
L8687
L8688




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



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