CSHCN Services Program 2010 > Physician > Benefits, Limitations, and Authorization Requirements

   
 

30.2.24.6 Erythropoietin Alfa (EPO) and Darbepoetin

EPO and darbepoietin (procedure codes J0881 and J0885) are benefits of the CSHCN Services Program for the following diagnosis codes:

Diagnosis Code
Description

042

Human immunodeficiency virus (HIV)

20300

Multiple myeloma without mention of remission

20301

Multiple myeloma in remission

2733

Macroglobulinemia

2800

Iron deficiency anemia secondary to blood loss (chronic)

2801

Iron deficiency anemia secondary to inadequate dietary iron intake

2808

Other specified iron deficiency anemias

2809

Unspecified iron deficiency anemia

2810

Pernicious anemia

2811

Other vitamin B12 deficiency anemia

2812

Folate-deficiency anemia

2813

Other specified megaloblastic anemias not elsewhere classified

2814

Protein-deficiency anemia

2818

Anemia associated with other specified nutritional deficiency

2819

Unspecified deficiency anemia

2820

Hereditary spherocytosis

2821

Hereditary elliptocytosis

2822

Anemias due to disorders of glutathione metabolism

2823

Other hemolytic anemias due to enzyme deficiency

28241

Sickle-cell thalassemia without crisis

28242

Sickle-cell thalassemia with crisis

28249

Other thalassemia

2825

Sickle-cell trait

28260

Sickle-cell disease, unspecified

28261

Hb-SS disease without crisis

28262

Hb-SS disease with crisis

28263

Sickle-cell/Hb-C disease without crisis

28264

Sickle-cell/Hb-C disease with crisis

28268

Other sickle-cell disease without crisis

28269

Other sickle-cell disease with crisis

2827

Other hemoglobinopathies

2828

Other specified hereditary hemolytic anemias

2829

Unspecified hereditary hemolytic anemia

2830

Autoimmune hemolytic anemias

28310

Unspecified nonautoimmune hemolytic amenia

28311

Hemolytic-uremic syndrome

28319

Other nonautoimmune hemolytic anemias

2832

Hemoglobinuria due to hemolysis from external causes

2839

Acquired hemolytic anemia, unspecified

28401

Constitutional red blood cell aplasiac

28409

Other constitutional aplastic anemia

2841

Pancytopenia

2842

Myelophthisis

28481

Red cell aplasia (acquired) (adult) (with thymoma)

28489

Other specified aplastic anemias

2849

Unspecified aplastic anemia

2850

Sideroblastic anemia

2851

Acute posthemorrhagic anemia

28521

Anemia in chronic kidney disease

28522

Anemia in neoplastic disease

28529

Anemia of other chronic illness

2853

Antineoplastic chemotherapy induced anemia

2858

Other specified anemias

2859

Unspecified anemia

40300

Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage I through stage IV, or unspecified

40301

Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end-stage renal disease

40310

Hypertensive chronic kidney disease, benign, with chronic kidney disease stage I through stage IV, or unspecified

40311

Hypertensive chronic kidney disease, benign, with chronic kidney disease stage V or end-stage renal disease

40390

Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified

40391

Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end-stage renal disease

40402

Hypertensive heart and chronic kidney disease, malignant, without heart failure and with chronic kidney disease stage V or end-stage renal disease

40403

Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage V or end-stage renal disease

40412

Hypertensive heart and chronic kidney disease, benign, without heart failure and with chronic kidney disease stage V or end-stage renal disease

40413

Hypertensive heart and chronic kidney disease, benign, with heart failure and chronic kidney disease stage V or end-stage renal disease

40492

Hypertensive heart and chronic kidney disease, unspecified, without heart failure and with chronic kidney disease stage V or end-stage renal disease

40493

Hypertensive heart and chronic kidney disease, unspecified, with heart failure and chronic kidney disease stage V or end-stage renal disease

586

Unspecified renal failure

58889

Other specified disorders resulting from impaired renal function

7140

Rheumatoid arthritis

99811

Hemorrhage complicating a procedure

V4983

Awaiting organ transplant status

V5811

Encounter for antineoplastic chemotherapy

V5812

Encounter for antineoplastic immunotherapy

V5844

Aftercare following organ transplant

In addition to the diagnosis codes listed above, procedure code J0885 may also be considered for reimbursement with the following diagnosis codes:

Diagnosis Code
Description

5851

Chronic kidney disease, Stage I

5852

Chronic kidney disease, Stage II (mild)

5853

Chronic kidney disease, Stage III (moderate)

5854

Chronic kidney disease, Stage IV (severe)

5855

Chronic kidney disease, Stage V

5856

End-stage renal disease

5859

Chronic kidney disease, unspecified

Procedure codes J0882 and J0886 are benefits of the CSHCN Services Program for the following diagnosis codes:

Diagnosis Code
Description

042

Human immunodeficiency virus (HIV)

40300

Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage I through stage IV, or unspecified

40301

Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end-stage renal disease

40310

Hypertensive chronic kidney disease, benign, with chronic kidney disease stage I through stage IV, or unspecified

40311

Hypertensive chronic kidney disease, benign, with chronic kidney disease stage V or end-stage renal disease

40390

Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified

40391

Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end-stage renal disease

40402

Hypertensive heart and chronic kidney disease, malignant, without heart failure and with chronic kidney disease stage V or end-stage renal disease

40403

Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage V or end-stage renal disease

40412

Hypertensive heart and chronic kidney disease, benign, without heart failure and with chronic kidney disease stage V or end-stage renal disease

40413

Hypertensive heart and chronic kidney disease, benign, with heart failure and chronic kidney disease stage V or end-stage renal disease

40492

Hypertensive heart and chronic kidney disease, unspecified, without heart failure and with chronic kidney disease stage V or end-stage renal disease

40493

Hypertensive heart and chronic kidney disease, unspecified, with heart failure and chronic kidney disease stage V or end-stage renal disease

5851

Chronic kidney disease, Stage I

5852

Chronic kidney disease, Stage II (mild)

5853

Chronic kidney disease, Stage III (moderate)

5854

Chronic kidney disease, Stage IV (severe)

5855

Chronic kidney disease, Stage V

5856

End-stage renal disease

5859

Chronic kidney disease, unspecified

586

Unspecified renal failure

V420

Kidney replaced by transplant

V560

Aftercare involving extracorporeal dialysis

V5631

Encounter for adequacy testing for hemodialysis

V5632

Encounter for adequacy testing for peritoneal dialysis

V568

Encounter other dialysis

EPO is limited to three injections per calendar week (Sunday through Saturday).


Texas Medicaid & Healthcare Partnership
CPT only copyright 2009 American Medical Association. All rights reserved.
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