JJ Part A and Part B Targeted Probe and Educate Active Medical Review List

Published 05/03/2022

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Code Type

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Part A

HCPCS

J9271

HCPCS J9271 — Pembrolizumab (Keytruda®)

Review of outpatient claims for HCPCS J9271 — Pembrolizumab (Keytruda®)

Part A 

HCPCS

J2505/J2506

HCPCS J2505 — Pegfilgrastim (Neulasta®), 6mg/ HCPCS J2506 — Pegfilgrastim (Neulasta®), excludes biosimilar, 0.5mg

Review of outpatient claims for HCPCS J2505; this code was retired as of 1/1/22. HCPCS J2506 is effective 1/1/22 for providers to bill

Part A 

HCPCS

J9311/ J9312

HCPCS J9311, J9312 — Rituximab (Rituxan®) 10 mg and Hyaluronidase/Rituximab, 10 mg

Review of outpatient claims for HCPCS J9311 & J9312 — Rituximab (Rituxan®) 10 mg  and Hyaluronidase/Rituximab, 10 mg

Part A 

HCPCS

J9035

HCPCS J9035 — Bevacizumab (Avastin®), 10mg

Review of outpatient claims for HCPCS J9035 — Bevacizumab (Avastin®), 10mg

Part A 

HCPCS

J0897

HCPCS J0897 — Denosumab (Prolia®)

Review of outpatient Claims for HCPCS J0897 — Denosumab (Prolia®)

Part A 

HCPCS

J1745

HCPCS J1745 — Infliximab (Remicade®)

Review of outpatient claims for HCPCS J1745 — Infliximab (Remicade®)

Part A

HCPCS

G0277

HCPCS G0277 — Hyperbaric Oxygen Therapy (HBO) 

Review of inpatient claims for HCPCS G0277 — Hyperbaric Oxygen Therapy (HBO) 

Part A

CPT®

97110

CPT 97110 — Therapeutic Exercise

Review of outpatient claims for CPT 97110 — Therapeutic Exercise

Part A 

CPT®

97112

CPT 97112 — Neuromuscular Reeducation

Review of Outpatient claims for Rehabilitation Services: CPT 97112 — Neuromuscular Reeducation

Part A 

CPT®

97140

CPT 97140 — Manual Therapy

Review of outpatient claims for CPT 97140 — Manual Therapy

Part A 

DRG

885

DRG 885 — Psychoses

Review of inpatient claims for DRG 885 — Psychoses

Part A 

IRF

A0604 – D0604

Inpatient Rehabilitation Services (IRF): 0604 — Neurological M<25.85

Review of Inpatient Rehabilitation Services (IRF): 0604 — Neurological M<25.85

Part A CPT 97110, 97112, 97140 Therapy Cap Review with KX Modifier Review of Outpatient claims for Therapy Services billed with a KX Modifier

Part A 

IRF

A0106 – D0106

Inpatient Rehabilitation Services (IRF): Stroke M<41.50 & A<84.50

Review of Inpatient Rehabilitation Services (IRF): Stroke M<41.50 & A<84.50

Part A 

HIPPS

ID, IE, JD, KA, KD, KE

Skilled Nursing Facility (SNF)

Review of Skilled Nursing Facility (SNF) Claims with an emphasis on codes in the following HIPPS categories: ID, IE, JD, KA, KD, KE

Part A 

CPT®

90999

CPT 90999 — End Stage Renal Disease (ESRD) — Renal Dialysis

Review of claims submitted for outpatient CPT — 90999 — End Stage Renal Disease (ESRD)

Part A 

HCPCS

G0491

HCPCS G0491 — End Stage Renal Disease (ESRD) — Renal Dialysis (Acute Kidney Injury)

Review of Claims submitted for Acute Kidney Injury without End Stage Renal Disease (ESRD) — Renal Dialysis

Part B

CPT®

66984

CPT 66984 — Extracapsular Cataract Removal with Insertion

Review of outpatient claims for CPT 66984 — Extracapsular Cataract Removal with Insertion

Part B

CPT®

97110

CPT 97110 — Therapeutic Exercise

Review of outpatient claims for CPT 97110 — Therapeutic Exercise

Part B

HCPCS

J0897

HCPCS J0897 — Denosumab (Prolia®)

Review of outpatient claims for HCPCS J0897 — Denosumab (Prolia®)

Part B

HCPCS

J2778

HCPCS J2778 — Ranibizumab (Lucentis®)

Review of outpatient claims for HCPCS J2778 — Ranibizumab (Lucentis®)

Part B

HCPCS

J1745

Infliximab (Remicade®)

Review of outpatient claims for Infliximab (Remicade®)

Part B 

HCPCS

J0178

HCPCS J0178 — Aflibercept (Eylea®) 

Review of outpatient claims for HCPCS J0178 — Aflibercept (Eylea®) 

Part B 

HCPCS

J9311/J9312

HCPCS J9311 & J9312 — Rituximab (Rituxan®)

Review of outpatient claims for HCPCS J9311 and J9312 — Rituximab (Rituxan®)

Part B 

HCPCS

J0717

HCPCS J0717 — Certolizumab (Cimzia®)

Review of outpatient claims for HCPCS J0717 — Certolizumab (Cimzia®)

Part B 

HCPCS

J0129

HCPCS J0129 — Abatacept (Orencia®)

Review of outpatient claims for HCPCS J0129 — Abatacept (Orencia®)

Part B 

CPT®

11042–11047

CPT 11042–11047 — Surgical Debridement 

Review of outpatient claims for Surgical Services: CPT 11042–11047 — Surgical Debridement 

Part B

CPT®

90960–90967

CPT 90960–90967 — ESRD — Monthly Outpatient ESRD-Related Services

Review of outpatient ESRD claims with CPTs — 90960–90967

Part B 

HCPCS

A0427/A0429/A0425

Ambulance Services (Emergent): HCPCS Codes A0429 — Basic Life Support, Emergency, A0427 — Advanced Life Support, Emergency, A0425 — Ground Mileage

Review of Ambulance claims for Ambulance Services (Emergent): HCPCS Codes A0429 — Basic Life Support, Emergency, A0427 — Advanced Life Support, Emergency, A0425 — Ground Mileage

Part B 

CPT®

93306

CPT 93306 — Echocardiography with Contrast

Review of outpatient claims for CPT 93306 — Echocardiography with Contrast

Part B

HCPCS

80305–80307/G0480–G0483

HCPCS 80305–80307/G0480–G0483 — Diagnostic Services: Clinical Labs

Review of Outpatient claims for Drugs of Abuse Laboratory Tests: HCPCS 80305–80307/G0480–G0483

Part B

CPT®

82542

CPT 82542 — Column Chromatography/Mass Spectrometry

Review of Outpatient claims for Drugs of Abuse Laboratory Tests: CPT 82542 — Column Chromatography/Mass Spectrometry

Part B

CPT®

80061

Diagnostic Services: Laboratory Tests CPT 80061 — (Lipid Panel)

Review of Outpatient claims for Drugs of Abuse Laboratory Tests: CPT 80061 (Lipid Panel)

Part B

CPT®

80061/83721

Diagnostic Services: Laboratory Tests CPT 80061 — (Lipid Panel)/CPT 83721 (Assay of Blood Lipoprotein)

Review of Outpatient claims for Drugs of Abuse Laboratory Tests: CPT 80061 (Lipid Panel)/CPT 83721 (Assay of Blood Lipoprotein)