Type of Bill: 13X, 14X, 22X, 23X, 71X, 74X, 75X
Revenue Codes: 300 - 319
Indications and Limitations
This test is performed to aid in the management of prostate cancer patients and in
detecting metastatic or persistent disease in patients following treatment.
HCPCS Codes: 84066
Diagnosis Codes for Coverage
| ICD-9-CM Code |
Description |
| 185 |
Malignant Neoplasm of Genitourinary Organs |
| 198.5 |
Malignant Neoplasm of Other and Unspecified Sites |
| 222.2 |
Benign Neoplasms |
| 233.4 |
Carcinoma In Situ |
| 236.5 |
Neoplasms of Uncertain Behavior |
| 239.5 |
Neoplasms of Unspecified Nature |
| 790.93 |
Nonspecific Abnormal Findings |
Category:
Pathology and Laboratory
Reason for Denial
Routine screening.
Noncovered Diagnosis Codes
Medicare does not cover the PAP (Prostatic Acid Phosphatase) test for
routine screening purposes.
Sources of Information
1996 CPT Book, American Medical Association, p. 305
Laboratory and Diagnostic Tests, Fifth Edition, Lippincott, 1996
Other Carriers' Policies
Coding Guides
Submit CPT code 84066 with the appropriate ICD-9 diagnosis code.
Documentation Required
ICD-9 diagnosis codes are required on claim.
Medical records must clearly document the medical necessity for the test and the frequency
of the test.
If documentation is requested for review, submit the following:
- History and Physical;
- MD orders/progress notes
- Diagnosis/reason for test
- Test results
- Itemization of charges
Comments
This policy is being adapted from the Carrier policy. It does not represent the sole
opinion of the Intermediary/Medical Director. This policy was developed in consultation
with the medical community via the Carrier Advisory Committee.
| Date of Notice and Comments: |
April 3, 1996 |
| Notice Period Date: |
October, 1996 |
| Effective Date of Policy: |
November 1, 1996 |
|