Covered for:
003.21
Salmonella meningitis
013.00–013.06
Tuberculous meningitis
013.40–013.46
Tuberculoma of spinal cord
013.50–013.56
Tuberculous abscess of spinal cord
013.60–013.66
Tuberculous encephalitis or myelitis
015.00–015.06
Tuberculosis of vertebral column
045.00–045.03
Acute paralytic poliomyelitis specified as bulbar
045.10–045.13
Acute poliomyelitis with other paralysis
045.20–045.23
Acute non-paralytic poliomyelitis
045.90–045.93
Acute poliomyelitis, unspecified
091.81
Acute syphilitic meningitis (secondary)
094.0–094.3
Neurosyphilis
094.81–094.87
Other specified neurosyphilis
094.89
Other specified neurosyphilis, other
094.9
Neurosyphilis, unspecified
098.82
Gonococcal meningitis
100.81
Leptospiral meningitis (aseptic)
112.83
Candidal meningitis
114.2
Coccidioidal meningitis
115.01
Histoplasma capsulatum meningitis
115.11
Histoplasma duboisii meningitis
130.0
Meningoencephalitis due to toxoplasmosis
140.0–140.1
Malignant neoplasm of lip
140.3–140.6
Malignant neoplasm of lip
140.8–140.9
Malignant neoplasm of lip
141.0–141.6
Malignant neoplasm of tongue
141.8–141.9
Malignant neoplasm of tongue
142.0–142.2
Malignant neoplasm of major salivary glands
142.8–142.9
Malignant neoplasm of major salivary glands
143.0–143.1
Malignant neoplasm of gum
143.8–143.9
Malignant neoplasm of gum
144.0–144.1
Malignant neoplasm of floor of mouth
144.8144.9
Malignant neoplasm of floor of mouth
145.0145.6
Malignant neoplasm of other and unspecified parts of mouth
145.8145.9
Malignant neoplasm of other and unspecified parts of mouth
146.0146.9
Malignant neoplasm of oropharynx
147.0–147.3
Malignant neoplasm of nasopharynx
147.8–147.9
Malignant neoplasm of nasopharynx
148.0–148.3
Malignant neoplasm of hypopharynx
148.8–148.9
Malignant neoplasm of hypopharynx
149.0–149.1
Malignant neoplasm of other and ill-defined sites within the lip, oral cavity, and pharynx
149.8–149.9
Malignant neoplasm of other and ill-defined sites within the lip, oral cavity, and pharynx
150.0–150.5
Malignant neoplasm of esophagus
150.8 -150.9
Malignant neoplasm of esophagus
151.0–151.6
Malignant neoplasm of stomach
151.8–151.9
Malignant neoplasm of stomach
152.0–152.3
Malignant neoplasm of small intestine, including duodenum
152.8–152.9
Malignant neoplasm of small intestine, including duodenum
153.0–153.9
Malignant neoplasm of colon
154.0–154.3
Malignant neoplasm of rectum, rectosigmoid junction, and anus
154.8
Malignant neoplasm of anus unspecified
155.0–155.2
Malignant neoplasm of liver and intrahepatic bile ducts
156.0–156.2
Malignant neoplasm of gallbladder and extrahepatic bile ducts
156.8–156.9
Malignant neoplasm of gallbladder and extrahepatic bile ducts
157.0–157.4
Malignant neoplasm of pancreas
157.8–157.9
Malignant neoplasm of pancreas
158.0
Malignant neoplasm of retroperitoneum
158.8
Malignant neoplasm of specified parts of peritoneum
159.0–159.1
Malignant neoplasm of other and ill-defined sites within the digestive organs and peritoneum
159.8–159.9
Malignant neoplasm of other and ill-defined sites within the digestive organs and peritoneum
160.0–160.5
Malignant neoplasm of nasal cavities, middle ear, and accessory sinuses
160.8–160.9
Malignant neoplasm of nasal cavities, middle ear, and accessory sinuses
161.0–161.3
Malignant neoplasm of larynx
161.8–161.9
Malignant neoplasm of larynx
162.0
Malignant neoplasm of trachea
162.2–162.5
Malignant neoplasm of trachea, bronchus, and lung
162.8–162.9
Malignant neoplasm of trachea, bronchus, and lung
163.0–163.1
Malignant neoplasm of pleura
163.8–163.9
Malignant neoplasm of pleura
164.0–164.3
Malignant neoplasm of thymus, heart, and mediastinum
164.8–164.9
Malignant neoplasm of thymus, heart, and mediastinum
165.0
Malignant neoplasm of upper respiratory tract, part unspecified
165.8–165.9
Malignant neoplasm of other and ill-defined sites within the respiratory system and intrathoracic organs
170.0–170.9
Malignant neoplasm of bone and articular cartilage
171.0
Malignant neoplasm of connective and other soft tissue, head, face and neck
171.2–171.9
Malignant neoplasm of connective and other soft tissue
172.0–172.9
Malignant melanoma of skin
173.0–173.9
Other malignant neoplasm of skin
174.0–174.6
Malignant neoplasm of female breast
174.8–174.9
Malignant neoplasm of female breast
175.0
Malignant neoplasm of male breast, nipple and areola
175.9
Malignant neoplasm of other and unspecified sites of male breast
176.0–176.5
Kaposi’s sarcoma
176.8–176.9
Kaposi’s sarcoma
179
Malignant neoplasm of uterus, part unspecified
180.0–180.1
Malignant neoplasm of cervix uteri
180.8–180.9
Malignant neoplasm of cervix uteri
181
Malignant neoplasm of placenta
182.0–182.1
Malignant neoplasm of body of uterus
182.8
Malignant neoplasm of other specified site of body of uterus
183.0
Malignant neoplasm of ovary
183.2–183.5
Malignant neoplasm of ovary and other uterine adnexa
183.8–183.9
Malignant neoplasm of ovary and other uterine adnexa
184.0–184.4
Malignant neoplasm of other and unspecified female genital organs
184.8–184.9
Malignant neoplasm of other and unspecified female genital organs
185
Malignant neoplasm of prostate
186.0
Malignant neoplasm of undescended testis
186.9
Malignant neoplasm of other and unspecified testis
187.1–187.9
Malignant neoplasm of penis and other male genital organs
188.0–188.9
Malignant neoplasm of bladder
189.0–189.4
Malignant neoplasm of kidney and other and unspecified urinary organs
189.8–189.9
Malignant neoplasm of kidney and other and unspecified urinary organs
190.0–190.9
Malignant neoplasm of eye
192.1–192.3
Malignant neoplasm of cerebral meninges, spinal cord, and spinal meninges
193
Malignant neoplasm of thyroid gland
194.6
Malignant neoplasm of aortic body and other paraganglia
195.0–195.5
Malignant neoplasm of other and ill-defined sites
195.8
Malignant neoplasm of other specified sites
196.0–196.3
Secondary and unspecified malignant neoplasm of lymph nodes
196.5–196.6
Secondary and unspecified malignant neoplasm of lymph nodes
196.8–196.9
Secondary and unspecified malignant neoplasm of lymph nodes
197.0–197.8
Secondary malignant neoplasm of respiratory and digestive systems
198.0*–198.7*
Secondary malignant neoplasm of other specified sites
198.81*–198.82*
Secondary malignant neoplasm of other specified sites
198.89*
Secondary malignant neoplasm of other specified sites
Note: Use 198.XX range of codes to indicate metastases to the spinal column.
199.0–199.2
Malignant neoplasm without specification of site
200.00–200.08
Reticulosarcoma
200.10–200.18
Lymphosarcoma
200.20–200.28
Burkitt’s tumor or lymphoma
200.30–200.38
Marginal zone lymphoma
200.40–200.48
Mantle cell lymphoma
200.50–200.58
Primary central nervous system lymphoma
200.60–200.68
Anaplastic large cell lymphoma
200.70–200.78
Large cell lymphoma
200.80–200.88
Lymphosarcoma and reticulosarcoma, other named variants
201.00–201.08
Hodgkin’s paragranuloma
201.10–201.18
Hodgkin’s granuloma
201.20–201.28
Hodgkin’s sarcoma
201.40–201.48
Hodgkin’s disease, lymphocytic-histiocytic predominance
201.50–201.58
Hodgkin’s disease, nodular sclerosis
201.60–201.68
Hodgkin’s disease, mixed cellularity
201.70–201.78
Hodgkin’s disease, lymphocytic depletion
201.90–201.98
Hodgkin’s disease, unspecified
202.00–202.08
Nodular lymphoma
202.10–202.18
Mycosis fungoides
202.20–202.28
Sezary’s disease
202.30–202.38
Malignant histiocytosis
202.40–202.48
Leukemic reticuloendotheliosis
202.50–202.58
Letterer-Siwe disease
202.60–202.68
Malignant mast cell tumors
202.70–202.78
Peripheral T cell lymphoma
202.80–202.88
Other lymphomas
202.90–202.98
Other and unspecified malignant neoplasms of lymphoid and histocytic tissue
203.00–203.02
Multiple myeloma
203.10–203.12
Plasma cell leukemia
203.80–203.82
Other immunoproliferative neoplasms
204.00–204.02
Acute lymphoid leukemia
204.10–204.12
Chronic lymphoid leukemia
204.20–204.22
Subacute lymphoid leukemia
204.80–204.82
Other lymphoid leukemia
204.90–204.92
Unspecified lymphoid leukemia
205.00–205.02
Acute myeloid leukemia
205.10–205.12
Chronic myeloid leukemia
205.20–205.22
Subacute myeloid leukemia
205.30–205.32
Myeloid sarcoma
205.80–205.82
Other myeloid leukemia
205.90–205.92
Unspecified myeloid leukemia
206.00–206.02
Acute monocytic leukemia
206.10–206.12
Chronic monocytic leukemia
206.20–206.22
Subacute monocytic leukemia
206.80–206.82
Other monocytic leukemia
206.90–206.92
Unspecified monocytic leukemia
207.00–207.02
Acute erythremia and erythroleukemia
207.10–207.12
Chronic erythremia
207.20–207.22
Megakaryocytic leukemia
207.80–207.82
Other specified leukemia
208.00–208.02
Acute leukemia of unspecified cell type
208.10–208.12
Chronic leukemia of unspecified cell type
208.20–208.22
Subacute leukemia of unspecified cell type
208.80–208.82
Other leukemia of unspecified cell type
208.90–208.92
Unspecified leukemia of unspecified cell type
213.2
Benign neoplasm of vertebral column, excluding sacrum and coccyx
213.9
Benign neoplasm of bone and articular cartilage, site unspecified
215.8–215.9
Other benign neoplasm of connective and other soft tissue
225.3–225.4
Benign neoplasm of other parts of nervous system
225.8–225.9
Benign neoplasm of other parts of nervous system
227.6
Benign neoplasm of aortic body and other paraganglia
228.00
Hemangioma of unspecified site
228.09
Hemangioma of other sites
237.3
Neoplasm of uncertain behavior of paraganglia
237.5–237.6
Neoplasm of uncertain behavior of endocrine glands and nervous system
237.70–237.73
Neurofibromatosis
237.79
Other neurofibromatosis
237.9
Neoplasm of uncertain behavior of other and unspecified parts of nervous system
238.0–238.1
Neoplasm of uncertain behavior of other and unspecified sites and tissues
238.6
Neoplasm of uncertain behavior of plasma cells
238.72–238.75
Neoplasm of uncertain behavior of other lymphatic and hematopoietic tissues
239.2
Neoplasm of unspecified nature of bone, soft tissue, and skin
239.6–239.7
Neoplasm of unspecified nature
239.89
Neoplasms of unspecified nature, other specified sites
320.0–320.3
Bacterial meningitis
320.7
Meningitis in other bacterial diseases classified elsewhere
320.81–320.82
Meningitis due to other specified bacteria
320.89
Meningitis due to other specified bacteria
320.9
Meningitis due to unspecified bacterium
321.0–321.4
Meningitis due to other organisms
321.8
Meningitis due to other non-bacterial organisms classified elsewhere
322.0–322.2
Meningitis of unspecified cause
322.9
Meningitis, unspecified
323.01–323.02
Encephalitis, myelitis, and encephalomyelitis in viral diseases, classified elsewhere
323.1–323.2
Encephalitis, myelitis, and encephalomyelitis
323.41–323.42
Other encephalitis, myelitis, and encephalomyelitis due to infection, classified elsewhere
323.52
Myelitis following immunization procedures
323.61–323.63
Postinfectious encephalitis, myelitis, and encephalomyelitis
323.71–323.72
Toxic encephalitis and encephalomyelitis – Toxic myelitis
323.81–323.82
Other causes of encephalitis, myelitis, and encephalomyelitis
323.9
Unspecified cause of encephalitis
324.1
Intraspinal abscess
326*
Late effects of intracranial abscess or pyogenic infection
Note: Use 326 to indicate late effects of syringomyelitis.
335.20–335.24
Motor neuron disease
335.29
Other motor neuron diseases
336.0–336.3
Other diseases of spinal cord
336.8*–336.9*
Other diseases of spinal cord
Note: Use 336.8 or 336.9 to indicate cord compression.
340
Multiple sclerosis
341.0–341.1
Other demyelinating diseases of central nervous system
341.8–341.9
Other demyelinating diseases of central nervous system
343.0–343.4
Infantile cerebral palsy
344.00–344.04
Other paralytic syndromes
344.09
Other quadriplegia
344.89
Other specified paralytic syndrome
349.1–349.2
Other and unspecified disorders of the nervous system
349.31
Accidental puncture or laceration of dura during a procedure
349.39
Other dural tear
353.3
Thoracic root lesions, not elsewhere classified
442.89*
Aneurysm of other specified site
Note: Use 442.89to indicate aneurysm of spinal artery.
720.0
Ankylosing spondylitis
720.81
Inflammatory spondylopathies in diseases classified elsewhere
721.41
Spondylosis with myelopathy, thoracic region
721.91
Spondylosis of unspecified site with myelopathy
722.11
Displacement of thoracic intervertebral disc without myelopathy
722.2
Displacement of intervertebral disc, site unspecified, without myelopathy
722.51
Degeneration of thoracic or thoracolumbar intervertebral disc
722.72
Intervertebral disc disorder with myelopathy, thoracic region
722.82
Postlaminectomy syndrome of thoracic region
722.92
Other and unspecified disc disorder of thoracic region
724.00–724.01
Spinal stenosis , other than cervical
724.4
Thoracic or lumbosacral neuritis or radiculitis, unspecified
730.08
Acute osteomyelitis involving other specified sites
730.18
Chronic osteomyelitis involving other specified sites
732.0
Juvenile osteochondrosis of spine
733.00–733.03
Other disorders of bone and cartilage, osteoporosis
733.09
Other osteoporosis
733.10–733.16
Other disorders of bone and cartilage, pathologic fracture
733.19
Pathologic fracture of other specified site
733.20–733.22
Other disorders of bone and cartilage, cyst of bone
733.29
Other bone cyst
733.3
Hyperostosis of skull
733.40–733.44
Other disorders of bone and cartilage, aseptic necrosis of bone
733.49
Aseptic necrosis of other bone sites
733.5–733.7
Other disorders of bone and cartilage
733.81–733.82
Malunion and non-union of fracture
733.90–733.92
Disorder of bone and cartilage, unspecified
733.99
Other disorders of bone and cartilage, other
737.0
Adolescent postural kyphosis
737.10–737.12
Curvature of spine, kyphosis (acquired)
737.19
Other kyphosis, (acquired) (postural)
737.20–737.22
Curvature of spine, lordosis (acquired)
737.29
Other lordosis, acquired
737.30–737.34
Curvature of spine, kyphoscoliosis and scoliosis
737.39
Other kyphoscoliosis and scoliosis
737.40–737.43
Curvature of spine associated with other conditions
737.8*–737.9*
Curvature of spine
Note: Use 737.8 or 737.9 to indicate patients with clinically significant symptoms or for pre-operative evaluation.
738.4
Acquired spondylolisthesis
741.00–741.02
Spina bifida, with hydrocephalus
741.90
Spina bifida, unspecified region, without mention of hydrocephalus
741.92
Spina bifida, thoracic region, without mention of hydrocephalus
742.51
Diastematomyelia
742.53
Hydromyelia
742.59
Other specified congenital anomalies of spinal cord
742.9
Unspecified congenital anomaly of brain, spinal cord, and nervous system
747.82
Spinal vessel anomaly
754.2
Congenital musculoskeletal deformities of spine
756.12
Spondylolisthesis, congenital
756.4
Chondrodystrophy
767.4
Injury to spine and spinal cord due to birth trauma
781.2
Abnormality of gait
781.4
Transient paralysis of limb
782.0
Symptom, disturbance of skin sensation
793.7*
Non-specific (abnormal) findings on radiological and other examination of musculoskeletal system
Note: Use 793.7 to indicate an abnormal bone scan.
793.91
Image test inconclusive due to excess body fat
793.99
Other nonspecific (abnormal) findings on radiological and other examination of body structure
805.2–805.3
Fracture of vertebral column without mention of spinal cord injury
805.8–805.9
Fracture of vertebral column without mention of spinal cord injury
806.20–806.29
Fracture of vertebral column with spinal cord injury, dorsal [thoracic], closed
806.30–806.39
Fracture of vertebral column with spinal cord injury, dorsal [thoracic], open
806.60–806.62
Fracture of vertebral column with spinal cord injury, sacrum and coccyx, closed
806.69
Closed fracture of sacrum and coccyx with other spinal cord injury
806.70–806.72
Fracture of vertebral column with spinal cord injury, sacrum and coccyx, open
806.79
Open fracture of sacrum and coccyx with other spinal cord injury
806.8–806.9
Fracture of vertebral column with spinal cord injury
839.21
Closed dislocation, thoracic vertebra
839.31
Open dislocation, thoracic vertebra
839.49
Closed dislocation, other vertebra, other
839.59
Open dislocation, other vertebra, other
909.2
Late effect of radiation
926.11
Crushing injury of back
952.10–952.19
Spinal cord injury without evidence of spinal bone injury, dorsal [thoracic]
952.8–952.9
Spinal cord injury without evidence of spinal bone injury
953.1
Injury to dorsal nerve root
List C
Medicare is establishing the following limited coverage for CPT/HCPCS codes 72131, 72132, 72133, 72148, 72149 and 72158 (CT and MRI of lumbar spine):
Covered for:
003.21
Salmonella meningitis
013.00–013.06
Tuberculous meningitis
013.40–013.46
Tuberculoma of spinal cord
013.50–013.56
Tuberculous abscess of spinal cord
013.60–013.66
Tuberculous encephalitis or myelitis
015.00–015.06
Tuberculosis of vertebral column
045.00–045.03
Acute paralytic poliomyelitis specified as bulbar
045.10–045.13
Acute poliomyelitis with other paralysis
045.20–045.23
Acute non-paralytic poliomyelitis
045.90–045.93
Acute poliomyelitis, unspecified
091.81
Acute syphilitic meningitis (secondary)
094.0–094.3
Neurosyphilis
094.81–094.87
Other specified neurosyphilis
094.89
Other specified neurosyphilis, other
094.9
Neurosyphilis, unspecified
098.82
Gonococcal meningitis
100.81
Leptospiral meningitis (aseptic)
112.83
Candidal meningitis
114.2
Coccidioidal meningitis
115.01
Histoplasma capsulatum meningitis
115.11
Histoplasma duboisii meningitis
130.0
Meningoencephalitis due to toxoplasmosis
140.0–140.1
Malignant neoplasm of lip
140.3–140.6
Malignant neoplasm of lip
140.8–140.9
Malignant neoplasm of lip
141.0–141.6
Malignant neoplasm of tongue
141.8–141.9
Malignant neoplasm of tongue
142.0–142.2
Malignant neoplasm of major salivary glands
142.8–142.9
Malignant neoplasm of major salivary glands
143.0–143.1
Malignant neoplasm of gum
143.8–143.9
Malignant neoplasm of gum
144.0–144.1
Malignant neoplasm of floor of mouth
144.8–144.9
Malignant neoplasm of floor of mouth
145.0–145.6
Malignant neoplasm of other and unspecified parts of mouth
145.8–145.9
Malignant neoplasm of other and unspecified parts of mouth
146.0–146.9
Malignant neoplasm of oropharynx
147.0–147.3
Malignant neoplasm of nasopharynx
147.8–147.9
Malignant neoplasm of nasopharynx
148.0–148.3
Malignant neoplasm of hypopharynx
148.8–148.9
Malignant neoplasm of hypopharynx
149.0–149.1
Malignant neoplasm of other and ill-defined sites within the lip, oral cavity, and pharynx
149.8–149.9
Malignant neoplasm of other and ill-defined sites within the lip, oral cavity, and pharynx
150.0–150.5
Malignant neoplasm of esophagus
150.8–150.9
Malignant neoplasm of esophagus
151.0–151.6
Malignant neoplasm of stomach
151.8–151.9
Malignant neoplasm of stomach
152.0–152.3
Malignant neoplasm of small intestine, including duodenum
152.8–152.9
Malignant neoplasm of small intestine, including duodenum
153.0–153.9
Malignant neoplasm of colon
154.0–154.3
Malignant neoplasm of rectum, rectosigmoid junction, and anus
154.8
Malignant neoplasm of anus unspecified
155.0–155.2
Malignant neoplasm of liver and intrahepatic bile ducts
156.0–156.2
Malignant neoplasm of gallbladder and extrahepatic bile ducts
156.8–156.9
Malignant neoplasm of gallbladder and extrahepatic bile ducts
157.0–157.4
Malignant neoplasm of pancreas
157.8–157.9
Malignant neoplasm of pancreas
158.0
Malignant neoplasm of retroperitoneum
158.8
Malignant neoplasm of specified parts of peritoneum
159.0–159.1
Malignant neoplasm of other and ill-defined sites within the digestive organs and peritoneum
159.8–159.9
Malignant neoplasm of other and ill-defined sites within the digestive organs and peritoneum
160.0–160.5
Malignant neoplasm of nasal cavities, middle ear, and accessory sinuses
160.8–160.9
Malignant neoplasm of nasal cavities, middle ear, and accessory sinuses
161.0–161.3
Malignant neoplasm of larynx
161.8–161.9
Malignant neoplasm of larynx
162.0
Malignant neoplasm of trachea
162.2–162.5
Malignant neoplasm of trachea, bronchus, and lung
162.8–162.9
Malignant neoplasm of trachea, bronchus, and lung
163.0–163.1
Malignant neoplasm of pleura
163.8–163.9
Malignant neoplasm of pleura
164.0–164.3
Malignant neoplasm of thymus, heart, and mediastinum
164.8–164.9
Malignant neoplasm of thymus, heart, and mediastinum
165.0
Malignant neoplasm of upper respiratory tract, part unspecified
165.8–165.9
Malignant neoplasm of other and ill-defined sites within the respiratory system and intrathoracic organs
170.0–170.9
Malignant neoplasm of bone and articular cartilage
171.0
Malignant neoplasm of connective and other soft tissue, head, face and neck
171.2–171.9
Malignant neoplasm of connective and other soft tissue
172.0–172.9
Malignant melanoma of skin
173.0–173.9
Other malignant neoplasm of skin
174.0–174.6
Malignant neoplasm of female breast
174.8–174.9
Malignant neoplasm of female breast
175.0
Malignant neoplasm of male breast, nipple and areola
175.9
Malignant neoplasm of other and unspecified sites of male breast
176.0–176.5
Kaposi’s sarcoma
176.8–176.9
Kaposi’s sarcoma
179
Malignant neoplasm of uterus, part unspecified
180.0–180.1
Malignant neoplasm of cervix uteri
180.8–180.9
Malignant neoplasm of cervix uteri
181
Malignant neoplasm of placenta
182.0–182.1
Malignant neoplasm of body of uterus
182.8
Malignant neoplasm of other specified site of body of uterus
183.0
Malignant neoplasm of ovary
183.2–183.5
Malignant neoplasm of ovary and other uterine adnexa
183.8–183.9
Malignant neoplasm of ovary and other uterine adnexa
184.0–184.4
Malignant neoplasm of other and unspecified female genital organs
184.8–184.9
Malignant neoplasm of other and unspecified female genital organs
185
Malignant neoplasm of prostate
186.0
Malignant neoplasm of undescended testis
186.9
Malignant neoplasm of other and unspecified testis
187.1–187.9
Malignant neoplasm of penis and other male genital organs
188.0–188.9
Malignant neoplasm of bladder
189.0–189.4
Malignant neoplasm of kidney and other and unspecified urinary organs
189.8–189.9
Malignant neoplasm of kidney and other and unspecified urinary organs
190.0–190.9
Malignant neoplasm of eye
192.1–192.3
Malignant neoplasm of cerebral meninges, spinal cord, and spinal meninges
193
Malignant neoplasm of thyroid gland
194.6
Malignant neoplasm of aortic body and other paraganglia
195.0–195.5
Malignant neoplasm of other and ill-defined sites
195.8
Malignant neoplasm of other specified sites
196.0–196.3
Secondary and unspecified malignant neoplasm of lymph nodes
196.5–196.6
Secondary and unspecified malignant neoplasm of lymph nodes
196.8–196.9
Secondary and unspecified malignant neoplasm of lymph nodes
197.0–197.8
Secondary malignant neoplasm of respiratory and digestive systems
198.0*–198.7*
Secondary malignant neoplasm of other specified sites
198.81*–198.82*
Secondary malignant neoplasm of other specified sites
198.89*
Secondary malignant neoplasm of other specified sites
Note: Use 198.XX range of codes to indicate metastases to the spinal column.
199.0–199.2
Malignant neoplasm without specification of site
200.00–200.08
Reticulosarcoma
200.10–200.18
Lymphosarcoma
200.20–200.28
Burkitt’s tumor or lymphoma
200.30–200.38
Marginal zone lymphoma
200.40–200.48
Mantle cell lymphoma
200.50–200.58
Primary central nervous system lymphoma
200.60–200.68
Anaplastic large cell lymphoma
200.70–200.78
Large cell lymphoma
200.80–200.88
Lymphosarcoma and reticulosarcoma, other named variants
201.00–201.08
Hodgkin’s paragranuloma
201.10–201.18
Hodgkin’s granuloma
201.20–201.28
Hodgkin’s sarcoma
201.40–201.48
Hodgkin’s disease, lymphocytic-histiocytic predominance
201.50–201.58
Hodgkin’s disease, nodular sclerosis
201.60–201.68
Hodgkin’s disease, mixed cellularity
201.70–201.78
Hodgkin’s disease, lymphocytic depletion
201.90–201.98
Hodgkin’s disease, unspecified
202.00–202.08
Nodular lymphoma
202.10–202.18
Mycosis fungoides
202.20–202.28
Sezary’s disease
202.30–202.38
Malignant histiocytosis
202.40–202.48
Leukemic reticuloendotheliosis
202.50–202.58
Letterer-Siwe disease
202.60–202.68
Malignant mast cell tumors
202.70–202.78
Peripheral T cell lymphoma
202.80–202.88
Other lymphomas
202.90–202.98
Other and unspecified malignant neoplasms of lymphoid and histocytic tissue
203.00–203.02
Multiple myeloma
203.10–203.12
Plasma cell leukemia
203.80–203.82
Other immunoproliferative neoplasms
204.00–204.02
Acute lymphoid leukemia
204.10–204.12
Chronic lymphoid leukemia
204.20–204.22
Subacute lymphoid leukemia
204.80–204.82
Other lymphoid leukemia
204.90–204.92
Unspecified lymphoid leukemia
205.00–205.02
Acute myeloid leukemia
205.10–205.12
Chronic myeloid leukemia
205.20–205.22
Subacute myeloid leukemia
205.30–205.32
Myeloid sarcoma
205.80–205.82
Other myeloid leukemia
205.90–205.92
Unspecified myeloid leukemia
206.00–206.02
Acute monocytic leukemia
206.10–206.12
Chronic monocytic leukemia
206.20–206.22
Subacute monocytic leukemia
206.80–206.82
Other monocytic leukemia
206.90–206.92
Unspecified monocytic leukemia
207.00–207.02
Acute erythremia and erythroleukemia
207.10–207.12
Chronic erythremia
207.20–207.22
Megakaryocytic leukemia
207.80–207.82
Other specified leukemia
208.00–208.02
Acute leukemia of unspecified cell type
208.10–208.12
Chronic leukemia of unspecified cell type
208.20–208.22
Subacute leukemia of unspecified cell type
208.80–208.82
Other leukemia of unspecified cell type
208.90–208.92
Unspecified leukemia of unspecified cell type
213.2
Benign neoplasm of vertebral column, excluding sacrum and coccyx
213.6
Benign neoplasm of pelvic bones, sacrum, and coccyx
213.9
Benign neoplasm of bone and articular cartilage, site unspecified
215.8–215.9
Other benign neoplasm of connective and other soft tissue
225.3–225.4
Benign neoplasm of brain and other parts of nervous system
225.8–225.9
Benign neoplasm of brain and other parts of nervous system
227.6
Benign neoplasm of aortic body and other paraganglia
228.00
Hemangioma of unspecified site
228.09
Hemangioma of other sites
237.3
Neoplasm of uncertain behavior of paraganglia
237.5–237.6
Neoplasm of uncertain behavior of endocrine glands and nervous system
237.70–237.73
Neurofibromatosis
237.79
Other neurofibromatosis
237.9
Neoplasm of uncertain behavior of other and unspecified parts of nervous system
238.0–238.1
Neoplasm of uncertain behavior of other and unspecified sites and tissues
238.6
Neoplasm of uncertain behavior of plasma cells
238.72–238.75
Neoplasm of uncertain behavior of other lymphatic and hematopoietic tissues
239.2
Neoplasm of unspecified nature of bone, soft tissue, and skin
239.6–239.7
Neoplasm of unspecified nature
239.89
Neoplasms of unspecified nature, other specified sites
320.0–320.3
Bacterial meningitis
320.7
Meningitis in other bacterial diseases classified elsewhere
320.81–320.82
Meningitis due to other specified bacteria
320.89
Meningitis due to other specified bacteria
320.9
Meningitis due to unspecified bacterium
321.0–321.4
Meningitis due to other organisms
321.8
Meningitis due to other non-bacterial organisms classified elsewhere
322.0–322.2
Meningitis of unspecified cause
322.9
Meningitis, unspecified
323.01–323.02
Encephalitis, myelitis, and encephalomyelitis in viral diseases, classified elsewhere
323.1–323.2
Encephalitis, myelitis, and encephalomyelitis
323.41–323.42
Other encephalitis, myelitis, and encephalomyelitis due to infection, classified elsewhere
323.52
Myelitis following immunization procedures
323.61–323.63
Postinfectious encephalitis, myelitis, and encephalomyelitis
323.71–323.72
Toxic encephalitis and encephalomyelitis – Toxic myelitis
323.81–323.82
Other causes of encephalitis, myelitis, and encephalomyelitis
323.9
Unspecified cause of encephalitis
324.1
Intraspinal abscess
326*
Late effects of intracranial abscess or pyogenic infection
Note: Use 326 to indicate late effects of syringomyelitis.
335.20–335.24
Motor neuron disease
335.29
Other motor neuron diseases
336.0–336.3
Other diseases of spinal cord
336.8*–336.9*
Other diseases of spinal cord
Note: Use 336.8 or 336.9 to indicate cord compression.
340
Multiple sclerosis
341.0–341.1
Other demyelinating diseases of central nervous system
341.8–341.9
Other demyelinating diseases of central nervous system
343.0–343.4
Infantile cerebral palsy
344.00–344.04
Other paralytic syndromes
344.09
Other quadriplegia
344.60–344.61
Other paralytic syndromes, cauda equina syndrome
344.89
Other specified paralytic syndrome
349.1–349.2
Other and unspecified disorders of the nervous system
349.31
Accidental puncture or laceration of dura during a procedure
349.39
Other dural tear
353.1
Lumbosacral plexus lesions
353.4
Lumbosacral root lesions, not elsewhere classified
353.8
Other nerve root and plexus disorders
355.71
Causalgia of lower limb
442.89*
Aneurysm of other specified site
Note: Use 442.89 to indicate aneurysm of spinal artery.
720.0
Ankylosing spondylitis
720.81
Inflammatory spondylopathies in diseases classified elsewhere
721.42
Spondylosis with myelopathy, lumbar region
721.91
Spondylosis of unspecified site with myelopathy
722.10
Displacement of lumbar intervertebral disc without myelopathy
722.2
Displacement of intervertebral disc, site unspecified, without myelopathy
722.52
Degeneration of lumbar or lumbosacral intervertebral disc
722.73
Intervertebral disc disorder with myelopathy, lumbar region
722.83
Postlaminectomy syndrome of lumbar region
722.93
Other and unspecified disc disorder of lumbar region
724.00
Spinal stenosis, unspecified region
724.02–724.03
Spinal stenosis, unspecified region
724.3–724.4
Other and unspecified disorders of back
730.08
Acute osteomyelitis involving other specified sites
730.18
Chronic osteomyelitis involving other specified sites
732.0
Juvenile osteochondrosis of spine
733.00–733.03
Other disorders of bone and cartilage, osteoporosis
733.09
Other osteoporosis
733.10–733.16
Other disorders of bone and cartilage, pathologic fracture
733.19
Pathologic fracture of other specified site
733.20–733.22
Other disorders of bone and cartilage, cyst of bone
733.29
Other bone cyst
733.3
Hyperostosis of skull
733.40–733.44
Other disorders of bone and cartilage, aseptic necrosis of bone
733.49
Aseptic necrosis of other bone sites
733.5–733.7
Other disorders of bone and cartilage
733.81–733.82
Malunion and non-union of fracture
733.90–733.92
Disorder of bone and cartilage, unspecified
733.99
Other disorders of bone and cartilage, other
737.0
Adolescent postural kyphosis
737.10–737.12
Curvature of spine, kyphosis (acquired)
737.19
Other kyphosis, (acquired) (postural)
737.20–737.22
Curvature of spine, lordosis (acquired)
737.29
Other lordosis, acquired
737.30–737.34
Curvature of spine, kyphoscoliosis and scoliosis
737.39
Other kyphoscoliosis and scoliosis
737.40–737.43
Curvature of spine associated with other conditions
737.8*–737.9*
Curvature of spine
Note: Use 737.8 or 737.9 to indicate patients with clinically significant symptoms or for pre-operative evaluation.
738.4
Acquired spondylolisthesis
741.00
Spina bifida, unspecified region, with hydrocephalus
741.03
Spina bifida, lumbar region, with hydrocephalus
741.90
Spina bifida, unspecified region, without mention of hydrocephalus
741.93
Spina bifida, lumbar region, without mention of hydrocephalus
742.51
Diastematomyelia
742.53
Hydromyelia
742.59
Other specified congenital anomalies of spinal cord
742.9
Unspecified congenital anomaly of brain, spinal cord, and nervous system
747.82
Spinal vessel anomaly
754.2
Congenital musculoskeletal deformities of spine
756.11–756.12
Anomalies of spine
756.17
Spina bifida occulta
756.4
Chondrodystrophy
767.4
Injury to spine and spinal cord due to birth trauma
781.2
Abnormality of gait
781.4
Transient paralysis of limb
782.0
Symptom, disturbance of skin sensation
793.7*
Non-specific (abnormal) findings on radiological and other examination of musculoskeletal system
Note: Use 793.7 to indicate an abnormal bone scan.
793.91
Image test inconclusive due to excess body fat
793.99
Other nonspecific (abnormal) findings on radiological and other examination of body structure
805.4–805.9
Closed fracture of lumbar vertebra without mention of spinal cord injury
806.4–806.5
Fracture of lumbar spine with spinal cord injury
806.60–806.62
Fracture of vertebral column with spinal cord injury, sacrum and coccyx, closed
806.69
Closed fracture of sacrum and coccyx with other spinal cord injury
806.70–806.72
Fracture of vertebral column with spinal cord injury, sacrum and coccyx, open
806.79
Open fracture of sacrum and coccyx with other spinal cord injury
839.20
Closed dislocation, lumbar vertebra
839.30
Open dislocation, lumbar vertebra
839.41–839.42
Other multiple and ill-defined dislocations, other vertebra, closed
839.49
Closed dislocation, other vertebra, other
839.51–839.52
Other multiple and ill-defined dislocations, other vertebra, open
839.59
Open dislocation, other vertebra, other
909.2
Late effect of radiation
926.11
Crushing injury of back
952.2–952.4
Spinal cord injury without evidence of spinal bone injury
952.8–952.9
Spinal cord injury without evidence of spinal bone injury
953.2–953.3
Injury to nerve roots and spinal plexus
Note: Providers should continue to submit ICD-9-CM diagnosis codes without decimals on their claim forms and electronic claims.
Diagnoses That Support Medical Necessity
N/A
ICD-9-CM Codes That DO NOT Support Medical Necessity
N/A
Diagnoses That DO NOT Support Medical Necessity
All diagnoses not listed in the “ICD-9-CM Codes that Support Medical Necessity” section of this LCD.
Documentation Requirements
Both MRI and CT scans may be necessary in certain circumstances. The medical record must clearly document the reasons for employing both imaging modalities.
Documentation supporting medical necessity should be legible, maintained in the patient’s medical record and made available to Medicare upon request.
Appendices
N/A
Utilization Guidelines
N/A
Sources of Information and Basis for Decision
J4 (CO, NM, OK, TX) MAC Consolidation
TrailBlazer adopted the TrailBlazer LCD, “Imaging of the Spine: MRI and CT,” for the Jurisdiction 4 (J4) MAC transition.
Full disclosure of the sources of information is found with original contractor LCD.
Other Contractor Local Coverage Determinations
“Imaging of the Spine: MRI and CT,” TrailBlazer LCD, (00400) L17094, (00900) L17100.
MRI and CT Scans of the Cervical, Thoracic and Lumbar Spine,” Noridian Administrative Services, LLC LCD, (CO) L14474 and L23880.
Start Date of Notice Period
12/20/2007
Revision History
Number
Date
Explanation
R4
01/01/2011
Per CR 7121 (Annual HCPCS Update), description changed for the GA modifier in the article. Effective date: 01/01/2011.
R3
10/18/2010
Use of LCD and related article made applicable to providers transitioning from WPS to TrailBlazer with addition of Contractor number 04901. Effective date: dates of service on or after 10/18/2010.
Per CR 7006 (Annual ICD-9-CM Diagnosis Coding Update), added diagnosis codes 237.73 and 237.79 to limited coverage List A (72125, 72126, 72127, 72141, 72142 and 72156), List B (72128, 72129, 72130, 72146, 72147 and 72157) and List C (72131, 72132, 72133, 72148, 72149 and 72158). Description changed for diagnosis code 724.02 and added 724.03 to List C. Effective date: 10/01/2010.
R2
10/01/2009
Per CR 6520, Annual ICD-9-CM Diagnosis Coding Update, added new diagnosis code 239.89 (neoplasms of unspecified nature, other specified sites) and corrected punctuation in the code descriptions for diagnosis codes 793.7 and 793.99 in the limited coverage for List A (72125, 72126, 72127, 72141, 72142, 72156), List B (72128, 72129, 72130, 72146, 72147, 72157) and List C (72131, 72132, 72133, 72148, 72149 and 72158). Effective date: 10/01/2009.
R1
10/01/2008
Per CR 6107 (Annual ICD–9–CM Diagnosis Coding Update) added new diagnosis codes 199.2, 203.02, 203.12, 203.82, 204.02, 204.12, 204.22, 204.82, 204.92, 205.02, 205.12, 205.22, 205.32, 205.82, 205.92, 206.02, 206.12, 206.22, 206.82, 206.92, 207.02, 207.12, 207.22, 207.82, 208.02, 208.12, 208.22, 208.82, 208.92, 349.31, 349.39 to limited coverage for HCPCS codes (List A: 72125, 72126, 72127, 72141, 72142, 72156) (List B: 72128, 72129, 72130, 72146, 72147, 72157) (List C: 72131, 72132, 72133, 72148, 72149 and 72158). Effective date: 10/01/2008.
N/A
06/13/2008
LCD effective in TX Part A and Part B and Part A CO and NM 06/13/2008
N/A
03/21/2008
LCD effective in CO Part B 03/21/2008
N/A
03/01/2008
LCD effective in NM Part B and OK Part A and Part B 03/01/2008
12/20/2007
Consolidated LCD posted for notice effective: 12/20/2007