Notification



Notification Issue Date:



Policy Attachment



Attachment to Policy # 12.00.01f


Attachment:A

Policy #:12.00.01f

Description:ICD-10 CM Codes Eligible to be Reported for Acupuncture

Title:Acupuncture (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.



97810, 97811, 97813, 97814 AND S8930 ARE MEDICALLY NECESSARY WHEN REPORTED WITH THE FOLLOWING ICD-10-CM DIAGNOSIS CODES:

G43.001 Migraine without aura, not intractable, with status migrainosus

G43.009 Migraine without aura, not intractable, without status migrainosus

G43.011 Migraine without aura, intractable, with status migrainosus

G43.019 Migraine without aura, intractable, without status migrainosus

G43.101 Migraine with aura, not intractable, with status migrainosus

G43.109 Migraine with aura, not intractable, without status migrainosus

G43.111 Migraine with aura, intractable, with status migrainosus

G43.119 Migraine with aura, intractable, without status migrainosus

G43.401 Hemiplegic migraine, not intractable, with status migrainosus

G43.409 Hemiplegic migraine, not intractable, without status migrainosus

G43.411 Hemiplegic migraine, intractable, with status migrainosus

G43.419 Hemiplegic migraine, intractable, without status migrainosus

G43.501 Persistent migraine aura without cerebral infarction, not intractable, with status migrainosus

G43.509 Persistent migraine aura without cerebral infarction, not intractable, without status migrainosus

G43.511 Persistent migraine aura without cerebral infarction, intractable, with status migrainosus

G43.519 Persistent migraine aura without cerebral infarction, intractable, without status migrainosus

G43.601 Persistent migraine aura with cerebral infarction, not intractable, with status migrainosus

G43.609 Persistent migraine aura with cerebral infarction, not intractable, without status migrainosus

G43.009 Migraine without aura, not intractable, without status migrainosus

G43.611 Persistent migraine aura with cerebral infarction, intractable, with status migrainosus

G43.619 Persistent migraine aura with cerebral infarction, intractable, without status migrainosus

G43.701 Chronic migraine without aura, not intractable, with status migrainosus

G43.709 Chronic migraine without aura, not intractable, without status migrainosus

G43.711 Chronic migraine without aura, intractable, with status migrainosus

G43.719 Chronic migraine without aura, intractable, without status migrainosus

G43.801 Other migraine, not intractable, with status migrainosus

G43.809 Other migraine, not intractable, without status migrainosus

G43.811 Other migraine, intractable, with status migrainosus

G43.819 Other migraine, intractable, without status migrainosus

G43.821 Menstrual migraine, not intractable, with status migrainosus

G43.829 Menstrual migraine, not intractable, without status migrainosus

G43.831 Menstrual migraine, intractable, with status migrainosus

G43.839 Menstrual migraine, intractable, without status migrainosus

G43.901 Migraine, unspecified, not intractable, with status migrainosus

G43.909 Migraine, unspecified, not intractable, without status migrainosus

G43.911 Migraine, unspecified, intractable, with status migrainosus

G43.919 Migraine, unspecified, intractable, without status migrainosus

G44.201 Tension-type headache, unspecified, intractable

G44.209 Tension-type headache, unspecified, not intractable

G44.211 Episodic tension-type headache, intractable

G44.219 Episodic tension-type headache, not intractable

G44.221 Chronic tension-type headache, intractable

G44.229 Chronic tension-type headache, not intractable

K91.0 Vomiting following gastrointestinal surgery

M16.0 Bilateral primary osteoarthritis of hip

M16.10 Unilateral primary osteoarthritis, unspecified hip

M16.11 Unilateral primary osteoarthritis, right hip

M16.12 Unilateral primary osteoarthritis, left hip

M16.2 Bilateral osteoarthritis resulting from hip dysplasia

M16.30 Unilateral osteoarthritis resulting from hip dysplasia, unspecified hip

M16.31 Unilateral osteoarthritis resulting from hip dysplasia, right hip

M16.32 Unilateral osteoarthritis resulting from hip dysplasia, left hip

M16.4 Bilateral post-traumatic osteoarthritis of hip

M16.50 Unilateral post-traumatic osteoarthritis, unspecified hip

M16.51 Unilateral post-traumatic osteoarthritis, right hip

M16.52 Unilateral post-traumatic osteoarthritis, left hip

M16.6 Other bilateral secondary osteoarthritis of hip

M16.7 Other unilateral secondary osteoarthritis of hip

M16.9 Osteoarthritis of hip, unspecified

M17.0 Bilateral primary osteoarthritis of knee

M17.10 Unilateral primary osteoarthritis, unspecified knee

M17.11 Unilateral primary osteoarthritis, right knee

M17.12 Unilateral primary osteoarthritis, left knee

M17.2 Bilateral post-traumatic osteoarthritis of knee

M17.30 Unilateral post-traumatic osteoarthritis, unspecified knee

M17.31 Unilateral post-traumatic osteoarthritis, right knee

M17.32 Unilateral post-traumatic osteoarthritis, left knee

M17.4 Other bilateral secondary osteoarthritis of knee

M17.5 Other unilateral secondary osteoarthritis of knee

M17.9 Osteoarthritis of knee, unspecified

M54.2 Cervicalgia

M54.5 Low back pain

O21.0 Mild hyperemesis gravidarum

O21.1 Hyperemesis gravidarum with metabolic disturbance

O21.2 Late vomiting of pregnancy

O21.8 Other vomiting complicating pregnancy

O21.9 Vomiting of pregnancy, unspecified

R11.2 Nausea with vomiting, unspecified

Version Effective Date: 01/01/2019
Version Issued Date: 01/02/2019
Version Reissued Date: 11/20/2019



2017 AmeriHealth.