Never Pay Procedures Under APG Reimbursement
- Also available in Excel Format (XLS,59KB) and Portable Document Format (PDF, 391KB, 5pg.)
Revised for April 1, 2013 Updates:
Information revised since the last update is highlighted.
Px Code | Procedure (Px) Description | Alternative Payment Available ∗ |
Date Added to Never Pay List |
Date Removed from Never Pay List |
---|---|---|---|---|
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 | 12/01/08 | |
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 |
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 | |
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 | |
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 | Hearing aid repair/modifying | 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.