Never Pay Procedures Under APG Reimbursement

Revised for July 1, 2014 Updates:

Information revised since the last update is highlighted.

Px Code Procedure (Px) Description Alternative
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Date
Added to
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Date
Removed from
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Date
subsequently
added to Never
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0126T Chd risk imt study No 01/01/13
0216T Njx paravert w/us lumb/sac No 01/01/13
0217T Njx paravert w/us lumb/sac No 01/01/13
0218T Njx paravert w/us lumb/sac No 01/01/13
0310T Motor function mapping ntms No 04/01/13
0311T Cal & alys cntrl artl press No 04/01/13
20696 Comp multiplane ext fixation No 01/01/13
20697 Comp ext fixate strut change No 01/01/13
20985 Cptr-asst dir ms px No 12/01/08
20986 Cptr-asst dir ms px io img No 12/01/08
20987 Cptr-asst dir ms px pre img No 12/01/08
27412 Autochondrocyte implant knee No 07/01/10
28890 High energy eswt, plantar f No 12/01/08
43257 Uppr gi scope w/thrml txmnt No 07/01/10
55400 Repair of sperm duct No 04/01/13
55706 Prostate saturation sampling No 07/01/10
58750 Repair oviduct No 10/01/09
70554 Fmri brain by tech No 12/01/08
74261 Ct colonography dx No 04/01/11
74262 Ct colonography dx w/dye No 04/01/11
74263 Ct colonography screening No 04/01/11
75571 Ct hrt w/o dye w/ca test No 04/01/11
75572 Ct hrt w/3d image No 04/01/11
75573 Ct hrt w/3d image congen No 04/01/11
75574 Ct angio hrt w/3d image No 04/01/11
77082 Dxa bone density vert fx No 10/01/12
77422 Neutron beam tx, simple No 04/01/09 07/01/10
77423 Neutron beam tx, complex No 04/01/09 07/01/10
83655 Assay of lead Yes 12/01/08
83890 Molecule isolate Yes 01/01/10
83891 Molecule isolate nucleic Yes 01/01/10
83892 Molecular diagnostics Yes 01/01/10
83893 Molecule dot/slot/blot Yes 01/01/10
83894 Molecule gel electrophor Yes 01/01/10
83896 Molecular diagnostics Yes 01/01/10
83897 Molecule nucleic transfer Yes 01/01/10
83898 Molecule nucleic ampli, each Yes 01/01/10
83900 Molecule nucleic ampli 2 seq Yes 01/01/10
83901 Molecule nucleic ampli addon Yes 01/01/10
83902 Molecular diagnostics Yes 01/01/10
83903 Molecule mutation scan Yes 01/01/10
83904 Molecule mutation identify Yes 01/01/10
83905 Molecule mutation identify Yes 01/01/10
83906 Molecule mutation identify Yes 01/01/10
83907 Lyse cells for nucleic ext Yes 01/01/10
83908 Nucleic acid, signal ampli Yes 01/01/10
83909 Nucleic acid, high resolute Yes 01/01/10
83912 Genetic examination Yes 01/01/10
83913 Molecular, rna stabilization Yes 01/01/10
83914 Mutation ident ola/sbce/aspe Yes 01/01/10
85004 Automated diff wbc count Yes 10/01/09
85610 Prothrombin time Yes 10/01/09
86849 Immunology procedure Yes 04/01/12
87536 Hiv-1, dna, quant Yes 12/01/08
87539 Hiv-2, dna, quant No 04/01/10
87900 Virtual phenotype Yes 01/01/10
87901 GeNo - APG Carve Outtype, dna, hiv reverse t Yes 12/01/08
87902 GeNo - APG Carve Outtype, dna, hepatitis C Yes 12/01/08
87903 PheNo - APG Carve Outtype, dna hiv w/culture Yes 12/01/08
87904 PheNo - APG Carve Outtype, dna hiv w/clt add Yes 10/01/09
87999 Microbiology procedure Yes 12/01/08
88230 Tissue culture, lymphocyte Yes 01/01/10
88233 Tissue culture, skin/biopsy Yes 01/01/10
88235 Tissue culture, placenta Yes 01/01/10
88237 Tissue culture, bone marrow Yes 01/01/10
88239 Tissue culture, tumor Yes 01/01/10
88240 Cell cryopreserve/storage Yes 01/01/10
88241 Frozen cell preparation Yes 01/01/10
88245 Chromosome analysis, 20-25 Yes 01/01/10
88248 Chromosome analysis, 50-100 Yes 01/01/10
88249 Chromosome analysis, 100 Yes 01/01/10
88261 Chromosome analysis, 5 Yes 01/01/10
88262 Chromosome analysis, 15-20 Yes 01/01/10
88263 Chromosome analysis, 45 Yes 01/01/10
88264 Chromosome analysis, 20-25 Yes 01/01/10
88267 Chromosome analys, placenta Yes 01/01/10
88269 Chromosome analys, amniotic Yes 01/01/10
88271 Cytogenetics, dna probe Yes 01/01/10
88272 Cytogenetics, 3-5 Yes 01/01/10
88273 Cytogenetics, 10-30 Yes 01/01/10
88274 Cytogenetics, 25-99 Yes 01/01/10
88275 Cytogenetics, 100-300 Yes 01/01/10
88280 Chromosome karyotype study Yes 01/01/10
88283 Chromosome banding study Yes 01/01/10
88285 Chromosome count, additional Yes 01/01/10
88289 Chromosome study, additional Yes 01/01/10
88291 Cyto/molecular report Yes 01/01/10
90470 H1N1 Administration Yes 10/01/09 07/01/11
90473 Immune admin oral/nasal Yes 10/01/09 04/01/11
90655 Flu vaccine no preserv 6-35m Yes 10/01/09 04/01/11
90656 Flu vaccine no preserv 3 & > Yes 10/01/09 04/01/11
90657 Flu vaccine, 3 yrs, im Yes 10/01/09 04/01/11
90658 Flu vaccine, 3 yrs & >, im Yes 10/01/09 04/01/11
90660 Flu vaccine, nasal Yes 10/01/09 04/01/11
90663 Flu vacc pandemic Yes 10/01/09 07/01/11
90669 Pneumococcal vacc, ped <5 Yes 10/01/09 04/01/11
90732 Pneumococcal vaccine Yes 10/01/09 04/01/11
90863 Pharmacologic mgmt w/psytx No 04/01/13
90875 Psychophysiological therapy No 07/01/10
90876 Psychophysiological therapy No 07/01/10
90880 Hypnotherapy No 04/01/09
90901 Biofeedback train, any meth No 07/01/10
90911 Biofeedback peri/uro/rectal No 07/01/10
95012 Exhaled nitric oxide meas No 12/01/08
95800 Slp stdy unattended No 01/01/13
95801 Slp stdy unatnd w/anal No 01/01/13
95806 Sleep study unatt&resp efft No 01/01/13
95965 Meg, spontaneous No 12/01/08
95966 Meg, evoked, single No 12/01/08
96102 Psycho testing by technician No 04/01/09 04/01/10
96119 Neuropsych testing by tec No 04/01/09 04/01/10
97012 Mechanical traction therapy No 04/01/13
97124 Massage therapy No 04/01/09 07/01/10
97150 Group therapeutic procedures No 04/01/09 04/01/10
97810 Acupunct w/o stimul 15 min No 04/01/09
97811 Acupunct w/o stimul addl 15m No 04/01/09
97813 Acupunct w/stimul 15 min No 04/01/09
97814 Acupunct w/stimul addl 15m No 04/01/09
98940 Chiropractic manipulation No 01/01/12
98941 Chiropractic manipulation No 04/01/11
98942 Chiropractic manipulation No 01/01/12
98943 Chiropractic manipulation No 01/01/12
99002 Device Handling No 04/01/11
0019T Extracorp shock wv tx,ms nos No 04/01/10
1000F Tobacco use assessed No 12/01/08
4000F Tobacco use txmnt counseling No 12/01/08
C9259 Injection, pralatrexate, 1 mg Yes 01/01/11
C9287 Inj, brentuximab vedotin Yes 07/01/12
C9716 Radiofrequency energy to anu No 07/01/10
D9221 General anesthesia ea ad 15m No 07/01/11
D9242 IV sedation ea ad 30 m No 07/01/11
D9920 Behavior management, by report No 12/01/08 07/01/11
G0008 Admin influenza virus vac Yes 10/01/09 04/01/11
G0009 Admin pneumococcal vaccine Yes 10/01/09 04/01/11
G0398 Home sleep test/type 2 Porta No 01/01/13
G0399 Home sleep test/type 3 Porta No 01/01/13
G0400 Home sleep test/type 4 Porta No 01/01/13
G8402 Smoke preven interven counse No 12/01/08
G8403 Smoke preven Outcounsel No 12/01/08
G9016 Demo-smoking cessation coun No 12/01/08
G9141 Influenza A (H1N1) - administration No 10/01/09 07/01/11
G9142 Influenza A (H1N1) - vaccine No 10/01/09 07/01/11
H0018 Alcohol and/or drug services No 07/01/10
H0023 Behavioral health outreach service - planned approach to reach a targeted population No 10/01/10
H0032 MH svc plan dev by non-md No 07/01/10
H0037 Comm psy sup tx pgm per diem No 07/01/10
H2029 Sex offend tx svc, per diem No 07/01/10
J0128 Injection, abarelix, 10 mg Yes 01/01/11
J0365 Injection, aprotonin, 10,000 kiu Yes 01/01/11
J0480 Injection, basiliximab, 20 mg Yes 01/01/11
J0585 Botulinum toxin a per unit Yes 12/01/08
J0587 Botulinum toxin type B Yes 12/01/08
J0740 Injection, cidofovir, 375 mg Yes 01/01/11
J0882 Darbepoetin alfa, esrd use Yes 12/01/08 01/01/12
J0886 Epoetin alfa 1000 units ESRD Yes 12/01/08 01/01/12 10/01/13
J0890 Peginesatide injection No 07/01/13
J1440 Filgrastim 300 mcg injection Yes 12/01/08
J1441 Filgrastim 480 mcg injection Yes 12/01/08
J1566 Injection, immune globulin, intravenous, lyophilized (e.g. powder), not otherwise specified, 500 mg Yes 01/01/11
J1675 Injection, histrelin acetate, 10 micrograms Yes 01/01/11
J1725 Hydroxyprogesterone caproate Yes 04/01/12
J1931 Injection, laronidase, 0.1 mg Yes 01/01/11
J2315 Naltrexone, depot form Yes - Only for Article 32 providers 01/01/10 07/01/11
J2323 Natalizumab injection Yes - only for TOUCH providers 01/01/10 01/01/11
J2358 Olanzapine long-acting inj Yes 04/01/11
J2426 Paliperidone palmitate inj Yes 04/01/11
J2505 Injection, pegfilgrastim 6mg Yes 12/01/08
J2562 Injection, plerixafor, 1 mg Yes 01/01/11
J2794 Risperidone, long acting Yes 04/01/09
J2997 Alteplase recombinant Yes 04/01/10 04/01/11
J3110 Injection, teriparatide, 10 mcg Yes 01/01/11
J3285 Injection, treprostinil, 1 mg Yes 01/01/11
J3490 Drugs unclassified injection Yes 04/01/10
J3590 Unclassified biologics Yes 04/01/10
J7187 Humate-P, inj Yes 12/01/08
J7189 Factor viia Yes 12/01/08
J7190 Factor viii Yes 12/01/08
J7191 Factor VIII (porcine) Yes 12/01/08
J7192 Factor viii recombinant Yes 12/01/08
J7193 Factor IX No - APG Carve Outn-recombinant Yes 12/01/08
J7194 Factor ix complex Yes 12/01/08
J7195 Factor IX recombinant Yes 12/01/08
J7197 Antithrombin iii injection Yes 12/01/08
J7198 Anti-inhibitor Yes 12/01/08
J7199 Hemophilia clot factor No - APG Carve Outc Yes 12/01/08
J7300 Intraut copper contraceptive Yes 12/01/08
J7302 LevoNo - APG Carve Outrgestrel iu contracept Yes 12/01/08
J7307 EtoNo - APG Carve Outgestrel implant system Yes 12/01/08
J8520 Capecitabine, oral, 150 mg Yes 01/01/11
J9001 Injection, doxorubicin hydrochloride, all lipid formulations, 10 mg Yes 01/01/11
J9019 Erwinaze injection Yes 07/01/14
J9027 Clofarabine injection Yes 12/01/08
J9033 Injection, bendamustine hcl, 1 mg Yes 01/01/11
J9035 Injection, bevacizumab, 10 mg Yes 01/01/11
J9055 Injection, cetuximab, 10 mg Yes 01/01/11
J9098 Injection, cytarabine liposome, 10 mg Yes 01/01/11
J9120 Injection, dactinomycin, 0.5 mg Yes 01/01/11
J9160 Injection, denileukin diftitox, 300 micrograms Yes 01/01/11
J9207 Injection, ixabepilone, 1 mg Yes 01/01/11
J9219 Leuprolide acetate implant, 65 mg Yes 01/01/11
J9225 Histrelin implant (vantas), 50 mg Yes 01/01/11
J9226 Supprelin LA implant Yes 10/01/10
J9245 Injection, melphalan hydrochloride, 50 mg Yes 01/01/11
J9263 Injection, oxaliplatin, 0.5 mg Yes 01/01/11
J9264 Injection, paclitaxel protein-bound particles, 1 mg Yes 01/01/11
J9266 Injection, pegaspargase, per single dose vial Yes 01/01/11
J9268 Injection, pentostatin, 10 mg Yes 01/01/11
J9303 Injection, panitumumab, 10 mg Yes 01/01/11
J9305 Injection, pemetrexed, 10 mg Yes 01/01/11
J9310 Injection, rituximab, 100 mg Yes 01/01/11
J9350 Injection, topotecan, 4 mg Yes 01/01/11
J9355 Injection, trastuzumab, 10 mg Yes 01/01/11
J9600 Injection, porfimer sodium, 75 mg Yes 01/01/11
Q0091 Obtaining screen pap smear No 01/01/12
Q2043 Provenge Yes 07/01/14
Q4074 Iloprost, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 20 micrograms Yes 01/01/11
S0166 Inj olanzapine 2.5mg No 04/01/11
S0190 Mifepristone, oral, 200 mg Yes 12/01/08
S0191 Misoprostol, oral, 200 mcg Yes 12/01/08
S3818 BRCA1 gene anal Yes 01/01/10
S3819 BRCA2 gene anal Yes 01/01/10
S3820 Comp BRCA1/BRCA2 Yes 01/01/10
S3822 Sing mutation brst/ovar Yes 01/01/10
S3823 3 mutation brst/ovar Yes 01/01/10
S3828 Comp MLH1 gene Yes 01/01/10
S3829 Comp MLH2 gene Yes 01/01/10
S3830 Gene test HNPCC comp Yes 01/01/10
S3831 Gene test HNPCC single Yes 01/01/10
S3833 Comp APC sequence Yes 01/01/10
S3834 Sing mutation APC Yes 01/01/10
S3835 Gene test cystic fibrosis Yes 01/01/10
S3840 DNA analysis RET-oncogene Yes 01/01/10
S3842 Gene test Hippel-Lindau Yes 01/01/10
S3843 DNA analysis factor v Yes 01/01/10
S3844 DNA analysis deafness Yes 01/01/10
S3845 Gene test alpha-thalassemia Yes 01/01/10
S3846 Gene test beta-thalassemia Yes 01/01/10
S3847 Gene test Tay-Sachs Yes 01/01/10
S3848 Gene test Gaucher Yes 01/01/10
S3849 Gene test Niemann-Pick Yes 01/01/10
S3850 Gene test sickle cell Yes 01/01/10
S3851 Gene test canavan Yes 01/01/10
S3852 DNA analysis APOE alzheimer Yes 01/01/10
S3853 Gene test myo musclr dyst Yes 01/01/10
S4989 Contracept IUD Yes 12/01/08
S8940 Hippotherapy per session No 12/01/08
S9075 Smoking cessation treatment No 12/01/08
S9128 Speech therapy, in the home, No 12/01/08
S9129 Occupational therapy, in the No 12/01/08
S9131 PT in the home per diem No 12/01/08
S9453 Smoking cessation class No 12/01/08
S9480 Intensive outpatient psychia No 07/01/10 01/01/11
V5014 Hearing aid repair/modifying Yes 04/01/12
V5362 Speech screening No 04/01/11
V5364 Dysphagia screening No 04/01/11

∗ Procedure codes listed as carve outs should not be billed using APGs. Indication as a carve out does not guarantee alternative payment.