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Preauthorization Requirement Changes Starting Oct. 15
and Jan. 1, 2024
Date Posted: 06/24/2024
The following codes will be added to the EmblemHealth Preauthorization List starting Oct. 15, 2024.
Codes Added to Preauthorization List Starting Oct. 15, 2024
| CPT/HCPCS Code | CPT Code Description |
|---|---|
0745T |
Cardiac focal ablation utilizing radiation therapy for arrhythmia; noninvasive arrhythmia localization and mapping of arrhythmia site (nidus), derived from anatomical image data (e.g., CT, MRI, or myocardial perfusion scan) and electrical data (e.g., 12-lead ECG data), and identification of areas of avoidance |
0746T |
Cardiac focal ablation utilizing radiation therapy for arrhythmia; conversion of arrhythmia localization and mapping of arrhythmia site (nidus) into a multidimensional radiation treatment plan |
0747T |
Cardiac focal ablation utilizing radiation therapy for arrhythmia; delivery of radiation therapy, arrhythmia |
0865T |
Quantitative magnetic resonance image (MRI) analysis of the brain with comparison to prior magnetic resonance (MR) study(ies), including lesion identification, characterization, and quantification, with brain volume(s) quantification and/or severity score, when performed, data preparation and transmission, interpretation, and report, obtained without diagnostic MRI examination of the brain during the same session |
0866T |
Quantitative magnetic resonance image (MRI) analysis of the brain with comparison to prior magnetic resonance (MR) study(ies), including lesion detection, characterization, and quantification, with brain volume(s) quantification and/or severity score, when performed, data preparation and transmission, interpretation and report, obtained with diagnostic MRI examination of the brain (List separately in addition to code for primary procedure) |
76873 |
Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure) |
93312 |
TEE 2D; including probe placement, image acquisition, interpretation, and report |
93313 |
Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording); placement of transesophageal probe only |
93314 |
Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording); image acquisition, interpretation, and report only |
93315 |
Transesophageal echocardiography for congenital cardiac anomalies; including probe placement, image acquisition, interpretation, and report |
A4239 |
Supply allowance for nonadjunctive, nonimplanted continuous glucose monitor (CGM), includes all supplies and accessories, one-month supply = 1 unit of service |
A4341 |
Indwelling intraurethral drainage device with valve, patient inserted, replacement only, each |
A4342 |
Accessories for patient inserted indwelling intraurethral drainage device with valve, replacement only, each |
A4457 |
Enema tube, with or without adapter, any type, replacement only, each |
A4468 |
An exsufflation belt is a stand-alone, intermittent abdominal daytime pressure ventilator device. |
A4540 |
Distal transcutaneous electrical nerve stimulator, stimulates peripheral nerves of the upper arm |
A4541 |
Monthly supplies for use of device coded at E0733 |
A4542 |
Supplies and accessories for external upper limb tremor stimulator of the peripheral nerves of the wrist |
A4560 |
Neuromuscular electrical stimulator (NMES), disposable, replacement only |
A4596 |
Cranial electrotherapy stimulation (CES) system supplies and accessories, per month |
A5508 |
For diabetics only, deluxe feature of off-the-shelf depth-inlay shoe or custom molded shoe, per shoe |
A5510 |
For diabetics only, direct formed, compression molded to patient's foot without external heat source, multiple-density insert(s) prefabricated, per shoe |
A6590 |
External urinary catheters; disposable, with wicking material, for use with suction pump, per month |
A6591 |
External urinary catheter; nondisposable, for use with suction pump, per month |
A9276 |
Sensor; invasive (e.g., subcutaneous), disposable, for use with nondurable medical equipment interstitial continuous glucose monitoring system (CGM), one unit = one day supply |
A9277 |
Transmitter; external, for use with nondurable medical equipment interstitial continuous glucose monitoring system (CGM) |
A9278 |
Receiver (monitor); external, for use with nondurable medical equipment interstitial continuous glucose monitoring system (CGM) |
E0492 |
Power source and control electronics unit for oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, controlled by phone application |
E0493 |
Oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, used in conjunction with the power source and control electronics unit, controlled by phone application, 90-day supply |
E0530 |
Electronic positional obstructive sleep apnea treatment, with sensor, includes all components and accessories, any type |
E0677 |
Nonpneumatic sequential compression garment, trunk |
E0732 |
Cranial electrotherapy stimulation (CES) system, any type |
E0733 |
Transcutaneous electrical nerve stimulator for electrical stimulation of the trigeminal nerve |
E0734 |
External upper limb tremor stimulator of the peripheral nerves of the wrist |
E0735 |
Noninvasive vagus nerve stimulator |
E0736 |
Transcutaneous tibial nerve stimulator |
E0738 |
Upper extremity rehabilitation system providing active assistance to facilitate muscle reeducation, includes microprocessor, all components and accessories |
E0739 |
Rehab system with interactive interface providing active assistance in rehabilitation therapy, includes all components and accessories, motors, microprocessors, sensors |
E1301 |
Whirlpool tub, walk-in, portable |
E2103 |
Nonadjunctive, nonimplanted continuous glucose monitor (CGM) or receiver |
E3000 |
Speech volume modulation system, any type, including all components and accessories |
K1004 |
Low frequency ultrasonic diathermy treatment device for home use |
The following code will be removed from the EmblemHealth Preauthorization List starting Jan. 1, 2024.
Code Removed From Preauthorization List Starting Jan. 1, 2024
| CPT/HCPCS Code | CPT Code Description |
|---|---|
93452 |
Left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed |