CSHCN 2009 > Physician > Benefits, Limitations, and Authorization Requirements

   
 

29.2.35.15 Septoplasty

Procedure code 30520 must be prior authorized and performed by a CSHCN Services Program provider that is a member of, or affiliated with, an approved cleft/craniofacial team when the surgery is performed for the repair and reconstruction of a cleft lip, cleft palate, or craniofacial anomaly. The CSHCN Services Program may reimburse septoplasty when billed with one of the following diagnosis codes:

Diagnosis Code
Description

1400

Malignant neoplasm of upper lip, vermilion border

1403

Malignant neoplasm of upper lip, inner aspect

1405

Malignant neoplasm of lip, inner aspect, unspecified as to upper or lower

1406

Malignant neoplasm of commissure of lip

1408

Malignant neoplasm of other sites of lip

1409

Malignant neoplasm of lip, vermilion border, unspecified as to upper or lower

1450

Malignant neoplasm of cheek mucosa

1451

Malignant neoplasm of vestibule of mouth

1452

Malignant neoplasm of hard palate

1453

Malignant neoplasm of soft palate

1454

Malignant neoplasm of uvula

1455

Malignant neoplasm of palate, unspecified

1456

Malignant neoplasm of retromolar area

1458

Malignant neoplasm of other specified parts of mouth

1470

Malignant neoplasm of superior wall of nasopharynx

1471

Malignant neoplasm of posterior wall of nasopharynx

1472

Malignant neoplasm of lateral wall of nasopharynx

1473

Malignant neoplasm of anterior wall of nasopharynx

1478

Malignant neoplasm of other specified sites of nasopharynx

1479

Malignant neoplasm of nasopharynx, unspecified site

1600

Malignant neoplasm of nasal cavities

1601

Malignant neoplasm of auditory tube, middle ear, and mastoid air cells

1602

Malignant neoplasm of maxillary sinus

1603

Malignant neoplasm of ethmoidal sinus

1604

Malignant neoplasm of frontal sinus

1605

Malignant neoplasm of sphenoidal sinus

1608

Malignant neoplasm of other sites of nasal cavities, middle ear, and accessory sinuses

1609

Malignant neoplasm of accessory sinus, unspecified site

1700

Malignant neoplasm of bones of skull and face, except mandible

1720

Malignant melanoma of skin of lip

1723

Malignant melanoma of skin of other and unspecified parts of face

1730

Other malignant neoplasm of skin of lip

1733

Other malignant neoplasm of skin of other and unspecified parts of face

1910

Malignant neoplasm of cerebrum, except lobes and ventricles

1911

Malignant neoplasm of frontal lobe of brain

1912

Malignant neoplasm of temporal lobe of brain

1913

Malignant neoplasm of parietal lobe of brain

1914

Malignant neoplasm of occipital lobe of brain

1915

Malignant neoplasm of ventricles of brain

1916

Malignant neoplasm of cerebellum NOS

1917

Malignant neoplasm of brain stem

1918

Malignant neoplasm of other parts of brain

1919

Malignant neoplasm of brain, unspecified site

1943

Malignant neoplasm of pituitary gland and craniopharyngeal duct

1944

Malignant neoplasm of pineal gland

1950

Malignant neoplasm of head, face, and neck

1960

Secondary and unspecified malignant neoplasm of lymph nodes of head, face, and neck

2120

Benign neoplasm of nasal cavities, middle ear, and accessory sinuses

2130

Benign neoplasm of bones of skull and face

2160

Benign neoplasm of skin of lip

2163

Benign neoplasm of skin of other and unspecified parts of face

2300

Carcinoma in situ of lip, oral cavity, and pharynx

2320

Carcinoma in situ of skin of lip

2351

Neoplasm of uncertain behavior of lip, oral cavity, and pharynx

2359

Neoplasm of uncertain behavior of other and unspecified respiratory organs

23770

Neurofibromatosis, unspecified

23771

Neurofibromatosis, Type 1 (von Recklinghausen's disease)

23772

Neurofibromatosis, Type 2 (acoustic neurofibromatosis)

27700

Cystic fibrosis without mention of meconium ileus

27701

Cystic fibrosis with meconium ileus

27702

Cystic fibrosis with pulmonary manifestations

27703

Cystic fibrosis with gastrointestinal manifestations

27709

Cystic fibrosis with other manifestations

52400

Unspecified major anomaly of jaw size

52401

Major maxillary hyperplasia

52402

Mandibular hyperplasia

52403

Maxillary hypoplasia

52404

Mandibular hypoplasia

52405

Macrogenia

52406

Microgenia

52407

Excessive tuberosity of jaw

52409

Other specified major anomaly of jaw size

52410

Unspecified anomaly of relationship of jaw to cranial base

5289

Other and unspecified diseases of the oral soft tissues

7380

Acquired deformity of nose

73810

Unspecified acquired deformity of head

74483

Macrostomia

74900

Unspecified cleft palate

74901

Unilateral cleft palate, complete

74902

Unilateral cleft palate, incomplete

74903

Bilateral cleft palate, complete

74904

Bilateral cleft palate, incomplete

74910

Unspecified cleft lip

74911

Unilateral cleft lip, complete

74912

Unilateral cleft lip, incomplete

74913

Bilateral cleft lip, complete

74914

Bilateral cleft lip, incomplete

74920

Unspecified cleft palate with cleft lip

74921

Unilateral cleft palate with cleft lip, complete

74922

Unilateral cleft palate with cleft lip, incomplete

74923

Bilateral cleft palate with cleft lip, complete

74924

Bilateral cleft palate with cleft lip, incomplete

74925

Other combinations of cleft palate with cleft lip

75026

Other specified congenital anomalies of mouth

75029

Other specified congenital anomalies of pharynx

7540

Congenital musculoskeletal deformities of skull, face, and jaw

9050

Late effect of fracture of skull and face bones

94130

Full-thickness skin loss due to burn (third degree NOS) of unspecified site of face and head

94131

Full-thickness skin loss due to burn (third degree NOS) of ear (any part)

94132

Full-thickness skin loss due to burn (third degree NOS) of eye (with other parts of face, head, and neck)

94133

Full-thickness skin loss due to burn (third degree NOS) of lip(s)

94134

Full-thickness skin loss due to burn (third degree NOS) of chin

94135

Full-thickness skin loss due to burn (third degree NOS) of nose (septum)

94136

Full-thickness skin loss due to burn (third degree NOS) of scalp (any part)

94137

Full-thickness skin loss due to burn (third degree NOS) of forehead and cheek

94138

Full-thickness skin loss due to burn (third degree NOS) of neck

94139

Full-thickness skin loss due to burn (third degree NOS) of multiple sites (except with eye) of face, head, and neck

94140

Deep necrosis of underlying tissues due to burn (deep third degree) of face and head, without mention of loss of a body part

94141

Deep necrosis of underlying tissues due to burn (deep third degree) of ear (any part), without mention of loss of a body part

94142

Deep necrosis of underlying tissues due to burn (deep third degree) of eye (with other parts of face, head, and neck), without mention of loss of a body part

94143

Deep necrosis of underlying tissues due to burn (deep third degree) of lip(s), without mention of loss of a body part

94144

Deep necrosis of underlying tissues due to burn (deep third degree) of chin, without mention of loss of a body part

94145

Deep necrosis of underlying tissues due to burn (deep third degree) of nose (septum), without mention of loss of a body part

94146

Deep necrosis of underlying tissues due to burn (deep third degree) of scalp (any part), without mention of loss of a body part

94147

Deep necrosis of underlying tissues due to burn (deep third degree) of forehead and cheek, without mention of loss of a body part

94148

Deep necrosis of underlying tissues due to burn (deep third degree) of neck, without mention of loss of a body part

94149

Deep necrosis of underlying tissues due to burn (deep third degree) of multiple sites (except with eye) of face, head, and neck, without mention of loss of a body part

94150

Deep necrosis of underlying tissues due to burn (deep third degree) of face and head, unspecified site, without mention of loss of a body part

94151

Deep necrosis of underlying tissues due to burn (deep third degree) of ear (any part), without mention of loss of a body part

94152

Deep necrosis of underlying tissues due to burn (deep third degree) of eye (with other parts of face, head, and neck), with loss of a body part

94153

Deep necrosis of underlying tissues due to burn (deep third degree) of lip(s), without mention of loss of a body part

94154

Deep necrosis of underlying tissues due to burn (deep third degree) of chin, without mention of loss of a body part

94155

Deep necrosis of underlying tissues due to burn (deep third degree) of nose (septum), without mention of loss of a body part

94156

Deep necrosis of underlying tissues due to burn (deep third degree) of scalp (any part), without mention of loss of a body part

94157

Deep necrosis of underlying tissues due to burn (deep third degree) of forehead and cheek, without mention of loss of a body part

94158

Deep necrosis of underlying tissues due to burn (deep third degree) of neck, without mention of loss of a body part

94159

Deep necrosis of underlying tissues due to burn (deep third degree) of multiple sites (except with eye) of face, head, and neck, without mention of loss of a body part

9470

Burn of mouth and pharynx

The CSHCN Services Program may reimburse CSHCN Services Program providers who are members of or affiliated with approved cleft/craniofacial teams. The CSHCN Services Program does not reimburse team members who are not enrolled as CSHCN Services Program providers. Professional services of the team members may be reimbursed the lower of the billed amount or the amount allowed by Texas Medicaid.


Texas Medicaid & Healthcare Partnership
CPT only copyright 2008 American Medical Association. All rights reserved.
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