Thursday 26 October 2017

Covered Conditions

Effective for services performed on or after April 28, 1989: 
For acute leukemia in remission for patients who have a high probability of relapse and who have no human leucocyte antigens (HLA)-matched, the following diagnosis codes are reported:

If ICD-9-CM is applicable, use the following Diagnosis Codes and Descriptions

Diagnosis Code Description 
204.01 Lymphoid leukemia, acute, in remission 
205.01 Myeloid leukemia, acute, in remission 
206.01 Monocytic leukemia, acute, in remission 
207.01 Acute erythremia and erythroleukemia, in remission 
208.01 Leukemia of unspecified cell type, acute, in remission

If ICD-10-CM is applicable, use the following Diagnosis Codes and Descriptions

C91.01 Acute lymphoblastic leukemia, in remission 
C92.01 Acute myeloblastic leukemia, in remission 
C92.41 Acute promyelocytic leukemia, in remission 
C92.51 Acute myelomonocytic leukemia, in remission 
C92.61 Acute myeloid leukemia with 11q23-abnormality in remission
C92.A1 Acute myeloid leukemia with multilineage dysplasia, in remission 
C93.01 Acute monoblastic/monocytic leukemia, in remission 
C94.01 Acute erythroid leukemia, in remission 
C94.21 Acute megakaryoblastic leukemia, in remission 
C94.41 Acute parmyelosis with myelofibrosis, in remission
C95.01 Acute leukemia of unspecified cell type, in remission

For resistant non-Hodgkin's lymphomas or those presenting with poor prognostic features following an initial response the following diagnosis codes are reported:


If ICD-9-CM is applicable, use the following code ranges:

200.00 - 200.08, 
200.10 - 00.18, 
200.20 - 200.28, 
200.80 - 200.88, 
202.00 - 202.08, 
202.80 - 202.88, and 
202.90 - 202.98.

If ICD-10-CM is applicable use the following code ranges:

C82.00 - C85.29, 
C85.80 - C86.6, 
C96.4, and
 C96.Z - C96.9.

For recurrent or refractory neuroblastoma (see ICD-9-CM Neoplasm by site, malignant for the appropriate diagnosis code)

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