Dietary supplements come in various forms, such as tablets, gummies, capsules, powders, liquids, and energy bars. And they include natural ingredients as vitamins, minerals, herbs, amino acids, and enzymes. These supplements can help you achieve a balance between the foods and nutrients you personally need, but they cannot replace the food. Excessive amounts of supplements can be bad for your health, even if they are considered “natural”. So, consult your healthcare provider before taking them. Dietary supplements are covered by NEXtCARE only if mentioned explicitly in the table of benefits, below are Examples of Dietary supplements:
Why are dietary supplements not covered by insurance?
There are many reasons that the insurance companies are not covering the dietary supplement below are some
What to do if your insurance policy does not cover dietary supplements?
When prescribing a dietary supplement please always inform the member about the policy exclusions, because most of the insurance plans are not covering it. If the policy is not covering dietary supplement, the below rejection reason will be received: The rejection reason mapped to M009: The rejection reason mapped to this denial is NCOV-003: Service(s) is (are) not covered.
For Members:
Proton pump inhibitors (PPIs) and histamine H2 antagonists (H2 blockers) are the most common medications prescribed for the treatment of gastroesophageal reflux disease (GERD) or peptic ulcer disease (PUD). The treatment usually begins with antacids or over-the-counter H2 blockers for mild symptoms.
Both medications work by blocking and decreasing the production of stomach acid, but PPIs are considered stronger and faster in reducing stomach acids. However, H2 receptor blockers specifically decrease the acid released in the evening, which is a common contributor to peptic ulcers.
Acid Refulx can be reduced or treated by life style chamges and Diet:
For Healthcare Providers:
Recommendations:
SPECIFICASS_DESC | MNEMONIC | ICD | SOURCE |
041.86 Helicobacter Pylori (H. Pylori) Infection | 41.86 | 041.86 | ICD-9 |
112.84 Candidal Esophagitis | 112.84 | 112.84 | ICD-9 |
251.5 Abnormality Of Secretion Of Gastrin | 251.5 | 251.5 | ICD-9 |
530.10 Esophagitis, Unspecified | 530.1 | 530.10 | ICD-9 |
530.11 Reflux Esophagitis | 530.11 | 530.11 | ICD-9 |
530.12 Acute esophagitis | 530.12 | 530.12 | ICD-9 |
530.13 Eosinophilic esophagitis | 530.13 | 530.13 | ICD-9 |
530.19 Other Esophagitis | 530.19 | 530.19 | ICD-9 |
530.20 Ulcer of esophagus without bleeding | 530.2 | 530.20 | ICD-9 |
530.21 Ulcer of esophagus with bleeding | 530.21 | 530.21 | ICD-9 |
531.00 Acute gastric ulcer with hemorrhage, without mention of obstruction | 531 | 531.00 | ICD-9 |
531.01 Acute gastric ulcer with hemorrhage and obstruction | 531.01 | 531.01 | ICD-9 |
531.10 Acute gastric ulcer with perforation, without mention of obstruction | 531.1 | 531.10 | ICD-9 |
531.11 Acute gastric ulcer with perforation and obstruction | 531.11 | 531.11 | ICD-9 |
531.20 Acute gastric ulcer with hemorrhage and perforation, without mention of obstruction | 531.2 | 531.20 | ICD-9 |
531.21 Acute gastric ulcer with hemorrhage, perforation, and obstruction | 531.21 | 531.21 | ICD-9 |
531.30 Acute gastric ulcer without mention of hemorrhage, perforation, or obstruction | 531.3 | 531.30 | ICD-9 |
531.31 Acute gastric ulcer without mention of hemorrhage or perforation, with obstruction | 531.31 | 531.31 | ICD-9 |
531.40 Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction | 531.4 | 531.40 | ICD-9 |
531.41 Chronic or unspecified gastric ulcer with hemorrhage and obstruction | 531.41 | 531.41 | ICD-9 |
531.50 Chronic or unspecified gastric ulcer with perforation, without mention of obstruction | 531.5 | 531.50 | ICD-9 |
531.51 Chronic or unspecified gastric ulcer with perforation and obstruction | 531.51 | 531.51 | ICD-9 |
531.60 Chronic or unspecified gastric ulcer with hemorrhage and perforation, without mention of obstruction | 531.6 | 531.60 | ICD-9 |
531.61 Chronic or unspecified gastric ulcer with hemorrhage, perforation, and obstruction | 531.61 | 531.61 | ICD-9 |
531.70 Chronic gastric ulcer without mention of hemorrhage, perforation, without mention of obstruction | 531.7 | 531.70 | ICD-9 |
531.71 Chronic gastric ulcer without mention of hemorrhage or perforation, with obstruction | 531.71 | 531.71 | ICD-9 |
531.90 Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage, perforation, or obstruction | 531.9 | 531.90 | ICD-9 |
531.91 Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, with obstruction | 531.91 | 531.91 | ICD-9 |
532.00 Acute duodenal ulcer with hemorrhage, without mention of obstruction | 532 | 532.00 | ICD-9 |
532.01 Acute duodenal ulcer with hemorrhage and obstruction | 532.01 | 532.01 | ICD-9 |
532.10 Acute duodenal ulcer with perforation, without mention of obstruction | 532.1 | 532.10 | ICD-9 |
532.11 Acute duodenal ulcer with perforation and obstruction | 532.11 | 532.11 | ICD-9 |
532.20 Acute duodenal ulcer with hemorrhage and perforation, without mention of obstruction | 532.2 | 532.20 | ICD-9 |
532.21 Acute duodenal ulcer with hemorrhage, perforation, and obstruction | 532.21 | 532.21 | ICD-9 |
532.30 Acute duodenal ulcer without mention of hemorrhage, perforation, or obstruction | 532.3 | 532.30 | ICD-9 |
532.31 Acute duodenal ulcer without mention of hemorrhage or perforation, with obstruction | 532.31 | 532.31 | ICD-9 |
532.40 Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction | 532.4 | 532.40 | ICD-9 |
532.41 Chronic or unspecified duodenal ulcer with hemorrhage and obstruction | 532.41 | 532.41 | ICD-9 |
532.50 Chronic or unspecified duodenal ulcer with perforation, without mention of obstruction | 532.5 | 532.50 | ICD-9 |
532.51 Chronic or unspecified duodenal ulcer with perforation and obstruction | 532.51 | 532.51 | ICD-9 |
532.60 Chronic or unspecified duodenal ulcer with hemorrhage and perforation, without mention of obstruction | 532.6 | 532.60 | ICD-9 |
532.61 Chronic or unspecified duodenal ulcer with hemorrhage, perforation, and obstruction | 532.61 | 532.61 | ICD-9 |
532.70 Chronic duodenal ulcer without mention of hemorrhage, perforation, or obstruction | 532.7 | 532.70 | ICD-9 |
532.71 Chronic duodenal ulcer without mention of hemorrhage or perforation, with obstruction | 532.71 | 532.71 | ICD-9 |
532.90 Duodenal ulcer, unspecified as acute or chronic, without hemorrhage, perforation, or obstruction | 532.9 | 532.90 | ICD-9 |
532.91 Duodenal ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, with obstruction | 532.91 | 532.91 | ICD-9 |
533.00 Acute peptic ulcer, unspecified site, with hemorrhage, without mention of obstruction | 533 | 533.00 | ICD-9 |
533.01 Acute peptic ulcer, unspecified site, with hemorrhage and obstruction | 533.01 | 533.01 | ICD-9 |
533.10 Acute peptic ulcer, unspecified site, with perforation, without mention of obstruction | 533.1 | 533.10 | ICD-9 |
533.11 Acute peptic ulcer, unspecified site, with perforation and obstruction | 533.11 | 533.11 | ICD-9 |
533.20 Acute peptic ulcer, unspecified site, with hemorrhage and perforation, without mention of obstruction | 533.2 | 533.20 | ICD-9 |
533.21 Acute peptic ulcer, unspecified site, with hemorrhage, perforation, and obstruction | 533.21 | 533.21 | ICD-9 |
533.30 Acute peptic ulcer, unspecified site, without mention of hemorrhage, perforation, or obstruction | 533.3 | 533.30 | ICD-9 |
533.31 Acute peptic ulcer, unspecified site, without mention of hemorrhage and perforation, with obstruction | 533.31 | 533.31 | ICD-9 |
533.40 Chronic or unspecified peptic ulcer, unspecified site, with hemorrhage, without mention of obstruction | 533.4 | 533.40 | ICD-9 |
533.41 Chronic or unspecified peptic ulcer, unspecified site, with hemorrhage and obstruction | 533.41 | 533.41 | ICD-9 |
533.50 Chronic or unspecified peptic ulcer, unspecified site, with perforation, without mention of obstruction | 533.5 | 533.50 | ICD-9 |
533.51 Chronic or unspecified peptic ulcer, unspecified site, with perforation and obstruction | 533.51 | 533.51 | ICD-9 |
533.60 Chronic or unspecified peptic ulcer, unspecified site, with hemorrhage and perforation, without mention of obstruction | 533.6 | 533.60 | ICD-9 |
533.61 Chronic or unspecified peptic ulcer, unspecified site, with hemorrhage, perforation, and obstruction | 533.61 | 533.61 | ICD-9 |
533.70 Chronic peptic ulcer, unspecified site, without mention of hemorrhage, perforation, or obstruction | 533.7 | 533.70 | ICD-9 |
533.71 Chronic peptic ulcer of unspecified site without mention of hemorrhage or perforation, with obstruction | 533.71 | 533.71 | ICD-9 |
533.90 Peptic ulcer, unspecified site, unspecified as acute or chronic, without mention of hemorrhage, perforation, or obstruction | 533.9 | 533.90 | ICD-9 |
533.91 Peptic ulcer, unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, with obstruction | 533.91 | 533.91 | ICD-9 |
534.00 Acute gastrojejunal ulcer with hemorrhage, without mention of obstruction | 534 | 534.00 | ICD-9 |
534.01 Acute gastrojejunal ulcer, with hemorrhage and obstruction | 534.01 | 534.01 | ICD-9 |
534.10 Acute gastrojejunal ulcer with perforation, without mention of obstruction | 534.1 | 534.10 | ICD-9 |
534.11 Acute gastrojejunal ulcer with perforation and obstruction | 534.11 | 534.11 | ICD-9 |
534.20 Acute gastrojejunal ulcer with hemorrhage and perforation, without mention of obstruction | 534.2 | 534.20 | ICD-9 |
534.21 Acute gastrojejunal ulcer with hemorrhage, perforation, and obstruction | 534.21 | 534.21 | ICD-9 |
534.30 Acute gastrojejunal ulcer without mention of hemorrhage, perforation, or obstruction | 534.3 | 534.30 | ICD-9 |
534.31 Acute gastrojejunal ulcer without mention of hemorrhage or perforation, with obstruction | 534.31 | 534.31 | ICD-9 |
534.40 Chronic or unspecified gastrojejunal ulcer with hemorrhage, without mention of obstruction | 534.4 | 534.40 | ICD-9 |
534.41 Chronic or unspecified gastrojejunal ulcer, with hemorrhage and obstruction | 534.41 | 534.41 | ICD-9 |
534.50 Chronic or unspecified gastrojejunal ulcer with perforation, without mention of obstruction | 534.5 | 534.50 | ICD-9 |
534.51 Chronic or unspecified gastrojejunal ulcer with perforation and obstruction | 534.51 | 534.51 | ICD-9 |
534.60 Chronic or unspecified gastrojejunal ulcer with hemorrhage and perforation, without mention of obstruction | 534.6 | 534.60 | ICD-9 |
534.61 Chronic or unspecified gastrojejunal ulcer with hemorrhage, perforation, and obstruction | 534.61 | 534.61 | ICD-9 |
534.70 Chronic gastrojejunal ulcer without mention of hemorrhage, perforation, or obstruction | 534.7 | 534.70 | ICD-9 |
534.71 Chronic gastrojejunal ulcer without mention of hemorrhage or perforation, with obstruction | 534.71 | 534.71 | ICD-9 |
534.90 Gastrojejunal ulcer, unspecified as acute or chronic, without mention of hemorrhage, perforation, or obstruction | 534.9 | 534.90 | ICD-9 |
534.91 Gastrojejunal ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, with obstruction | 534.91 | 534.91 | ICD-9 |
535.00 Acute gastritis without mention of hemorrhage | 535 | 535.00 | ICD-9 |
535.01 Acute gastritis with hemorrhage | 535.01 | 535.01 | ICD-9 |
535.10 Atrophic gastritis without mention of hemorrhage | 535.1 | 535.10 | ICD-9 |
535.11 Atrophic gastritis with hemorrhage | 535.11 | 535.11 | ICD-9 |
535.20 Gastric mucosal hypertrophy without mention of hemorrhage | 535.2 | 535.20 | ICD-9 |
535.21 Gastric mucosal hypertrophy with hemorrhage | 535.21 | 535.21 | ICD-9 |
535.40 Other specified gastritis without mention of hemorrhage | 535.4 | 535.40 | ICD-9 |
535.41 Other specified gastritis with hemorrhage | 535.41 | 535.41 | ICD-9 |
535.50 Unspecified gastritis and gastroduodenitis without mention of hemorrhage | 535.5 | 535.50 | ICD-9 |
535.51 Unspecified gastritis and gastroduodenitis with hemorrhage | 535.51 | 535.51 | ICD-9 |
535.70 Eosinophilic gastritis, without mention of hemorrhage | 535.7 | 535.70 | ICD-9 |
535.71 Eosinophilic gastritis, with hemorrhage | 535.71 | 535.71 | ICD-9 |
536.8 Dyspepsia And Other Specified Disorders Of Function Of Stomach | 536.8 | 536.8 | ICD-9 |
787.1 Heartburn | 787.1 | 787.1 | ICD-9 |
789.06 Abdominal pain, epigastric | 789.06 | 789.06 | ICD-9 |
789.46 Abdominal rigidity, epigastric | 789.46 | 789.46 | ICD-9 |
789.66 Abdominal tenderness, epigastric | 789.66 | 789.66 | ICD-9 |
B37.81 Candidal esophagitis | B37.81 | B37.81 | ICD-10 |
B96.81 Helicobacter pylori [H. pylori] as the cause of diseases classified elsewhere | B96.81 | B96.81 | ICD-10 |
E16.4 Increased secretion of gastrin | E16.4 | E16.4 | ICD-10 |
K20.0 Eosinophilic esophagitis | K20.0 | K20.0 | ICD-10 |
K20.8 Other esophagitis | K20.8 | K20.8 | ICD-10 |
K20.9 Esophagitis, unspecified | K20.9 | K20.9 | ICD-10 |
K21.0 Gastro-esophageal reflux disease with esophagitis | K21.0 | K21.0 | ICD-10 |
K21.9 Gastro-esophageal reflux disease without esophagitis | K21.9 | K21.9 | ICD-10 |
K22.10 Ulcer of esophagus without bleeding | K22.10 | K22.10 | ICD-10 |
K22.11 Ulcer of esophagus with bleeding | K22.11 | K22.11 | ICD-10 |
K25.0 Acute gastric ulcer with hemorrhage | K25.0 | K25.0 | ICD-10 |
K25.1 Acute gastric ulcer with perforation | K25.1 | K25.1 | ICD-10 |
K25.2 Acute gastric ulcer with both hemorrhage and perforation | K25.2 | K25.2 | ICD-10 |
K25.3 Acute gastric ulcer without hemorrhage or perforation | K25.3 | K25.3 | ICD-10 |
K25.4 Chronic or unspecified gastric ulcer with hemorrhage | K25.4 | K25.4 | ICD-10 |
K25.5 Chronic or unspecified gastric ulcer with perforation | K25.5 | K25.5 | ICD-10 |
K25.6 Chronic or unspecified gastric ulcer with both hemorrhage and perforation | K25.6 | K25.6 | ICD-10 |
K25.7 Chronic gastric ulcer without hemorrhage or perforation | K25.7 | K25.7 | ICD-10 |
K25.9 Gastric ulcer, unspecified as acute or chronic, without hemorrhage or perforation | K25.9 | K25.9 | ICD-10 |
K26.0 Acute duodenal ulcer with hemorrhage | K26.0 | K26.0 | ICD-10 |
K26.1 Acute duodenal ulcer with perforation | K26.1 | K26.1 | ICD-10 |
K26.2 Acute duodenal ulcer with both hemorrhage and perforation | K26.2 | K26.2 | ICD-10 |
K26.3 Acute duodenal ulcer without hemorrhage or perforation | K26.3 | K26.3 | ICD-10 |
K26.4 Chronic or unspecified duodenal ulcer with hemorrhage | K26.4 | K26.4 | ICD-10 |
K26.5 Chronic or unspecified duodenal ulcer with perforation | K26.5 | K26.5 | ICD-10 |
K26.6 Chronic or unspecified duodenal ulcer with both hemorrhage and perforation | K26.6 | K26.6 | ICD-10 |
K26.7 Chronic duodenal ulcer without hemorrhage or perforation | K26.7 | K26.7 | ICD-10 |
K26.9 Duodenal ulcer, unspecified as acute or chronic, without hemorrhage or perforation | K26.9 | K26.9 | ICD-10 |
K27.0 Acute peptic ulcer, site unspecified, with hemorrhage | K27.0 | K27.0 | ICD-10 |
K27.1 Acute peptic ulcer, site unspecified, with perforation | K27.1 | K27.1 | ICD-10 |
K27.2 Acute peptic ulcer, site unspecified, with both hemorrhage and perforation | K27.2 | K27.2 | ICD-10 |
K27.3 Acute peptic ulcer, site unspecified, without hemorrhage or perforation | K27.3 | K27.3 | ICD-10 |
K27.4 Chronic or unspecified peptic ulcer, site unspecified, with hemorrhage | K27.4 | K27.4 | ICD-10 |
K27.5 Chronic or unspecified peptic ulcer, site unspecified, with perforation | K27.5 | K27.5 | ICD-10 |
K27.6 Chronic or unspecified peptic ulcer, site unspecified, with both hemorrhage and perforation | K27.6 | K27.6 | ICD-10 |
K27.7 Chronic peptic ulcer, site unspecified, without hemorrhage or perforation | K27.7 | K27.7 | ICD-10 |
K27.9 Peptic ulcer, site unspecified, unspecified as acute or chronic, without hemorrhage or perforation | K27.9 | K27.9 | ICD-10 |
K28.0 Acute gastrojejunal ulcer with hemorrhage | K28.0 | K28.0 | ICD-10 |
K28.1 Acute gastrojejunal ulcer with perforation | K28.1 | K28.1 | ICD-10 |
K28.2 Acute gastrojejunal ulcer with both hemorrhage and perforation | K28.2 | K28.2 | ICD-10 |
K28.3 Acute gastrojejunal ulcer without hemorrhage or perforation | K28.3 | K28.3 | ICD-10 |
K28.4 Chronic or unspecified gastrojejunal ulcer with hemorrhage | K28.4 | K28.4 | ICD-10 |
K28.5 Chronic or unspecified gastrojejunal ulcer with perforation | K28.5 | K28.5 | ICD-10 |
K28.6 Chronic or unspecified gastrojejunal ulcer with both hemorrhage and perforation | K28.6 | K28.6 | ICD-10 |
K28.7 Chronic gastrojejunal ulcer without hemorrhage or perforation | K28.7 | K28.7 | ICD-10 |
K28.9 Gastrojejunal ulcer, unspecified as acute or chronic, without hemorrhage or perforation | K28.9 | K28.9 | ICD-10 |
K29.00 Acute gastritis without bleeding | K29.00 | K29.00 | ICD-10 |
K29.01 Acute gastritis with bleeding | K29.01 | K29.01 | ICD-10 |
K29.30 Chronic superficial gastritis without bleeding | K29.30 | K29.30 | ICD-10 |
K29.31 Chronic superficial gastritis with bleeding | K29.31 | K29.31 | ICD-10 |
K29.40 Chronic atrophic gastritis without bleeding | K29.40 | K29.40 | ICD-10 |
K29.41 Chronic atrophic gastritis with bleeding | K29.41 | K29.41 | ICD-10 |
K29.50 Unspecified chronic gastritis without bleeding | K29.50 | K29.50 | ICD-10 |
K29.51 Unspecified chronic gastritis with bleeding | K29.51 | K29.51 | ICD-10 |
K29.60 Other gastritis without bleeding | K29.60 | K29.60 | ICD-10 |
K29.61 Other gastritis with bleeding | K29.61 | K29.61 | ICD-10 |
K29.70 Gastritis, unspecified, without bleeding | K29.70 | K29.70 | ICD-10 |
K29.71 Gastritis, unspecified, with bleeding | K29.71 | K29.71 | ICD-10 |
K30 Functional dyspepsia | K30 | K30 | ICD-10 |
K52.81 Eosinophilic gastritis or gastroenteritis | K52.81 | K52.81 | ICD-10 |
R10.13 Epigastric pain | R10.13 | R10.13 | ICD-10 |
R10.816 Epigastric abdominal tenderness | R10.816 | R10.816 | ICD-10 |
R10.826 Epigastric rebound abdominal tenderness | R10.826 | R10.826 | ICD-10 |
R12 Heartburn | R12 | R12 | ICD-10 |
References:
What is COVID-19?
Corona Virus Infectious Disease, first incident happened in 2019 is called, COVID-19.
What are the symptoms of COVID-19?
Most common symptoms: Fever, Dry Cough, Tiredness/Fatigue, and Loss of sense of taste & smell. However, serious symptoms include: Difficulty of breathing or severe shortness of breath, chest pain or pressure, loss of speech or movement.
What should I do if I have symptoms in UAE?
It’s very important to start isolating yourself and visit the nearest network healthcare provider to check if it’s necessary to do the PCR test.
Does my insurance cover COVID-19 test?
Am I covered for COVID-19 test and treatment outside UAE?
COVID-19 tests and treatment undergone abroad are not part of your UAE health insurance coverage.
Who do I call if I need more information?
What is circumcision?
Circumcision refers to the removal of the foreskin, or prepuce that covers the glans penis (head of the penis).
Baby Vs Adult Circumcision
Circumcision surgery on male babies is fairly straightforward and commonplace. It is usually done for religious, medical or personal-choice reasons. However, the procedure in adults is less frequent, and more complicated in terms of surgical accuracy and skill required to achieve optimal patient results. Recovery time varies according to the age and general health of the person. A baby or child will generally heal in five to seven days after the procedure, while in adults, recovery can take around two to three weeks. If the circumcision is performed during the newborn period, it will take only about five to 10 minutes and it is performed under local anesthesia. For adults, it usually takes an hour approximately and it is performed under general anesthesia.
What are the indications for male circumcision?
Does my insurance cover Circumcision?
Coverage of Circumcision varies with different insurance policies and different local regulations: For Dubai based policy (DHA), medical necessary circumcision is covered for members upto 2 years old or below and will require prior approval. For Abu Dhabi based policy (DOH), circumcision is not covered. For Northern emirates, coverage of circumcisionvaries according to the table of benefit for each policy, please always all NEXtCARE to check if circumcision is covered.
For Medically Necessary Cases (e.g., Balanophospitis, Balanitis & Emergency Paraphimosis) detailed Medical report/s with confirmed clinical findings, medical management showing no improvements and has been exhausted, must be submitted at the pre-authorization level.
The below ICD-10 codes to be used:
ICD | Description |
C60.0-C60.9 | Malignant neoplasm of penis |
D07.4 | Carcinoma in situ of penis |
D29.0 | Benign neoplasm of penis |
D40.8 | Neoplasm of uncertain behavior of other specified male genital organs |
N47.0-N47.8 | Disorders of prepuce |
N48.0 | Leukoplakia of penis |
N48.1 | Balanitis |
Q54.0-Q54.9 | Hypospadias |
S31.20XA-S31.25XS | Open wound of penis |
S38.01XA-S38.01XS | Crushing injury of penis |
Z40.8-Z40.9 | Encounter for other/unspecified prophylactic surgery |
According to the procedure, use the below CPT codes:
CPT | Description |
54150 | Circumcision, using clamp or other device with regional dorsal penile or ring block (all age) |
54160 | Circumcision, surgical excision other than clamp, device, or dorsal slit; neonate (28 days of age or less) |
54161 | older than 28 days of age |
54162 | Lysis or excision of penile post-circumcision adhesions |
54163 | Repair incomplete circumcision |
54164 | Frenulotomy of penis |
References:
Immunization
Dubai (DHA) Policy:
DHA immunization schedule for children between 0-6 years | |
Age | Vaccines |
At Birth | BCG, Hep B. |
Two months | DPT, Hib, Hep B, OPV, PCV. |
Four months | DPT, Hib, Hep B, OPV, PCV. |
Six months | DPT, Hib, Hep B, OPV, PCV. |
12 months | MMR, varicella |
18 months | DTaP, Hib, OPV, PCV. |
Five to six years | DPT, OPV, MMR, varicella. |
Reference for DHA:
https://www.dha.gov.ae/Documents/HRD/Immunization%20Guidelines.pdf
Abu Dhabi (DOH) Policy:
Vaccine and vaccine administration services are mostly Excluded under DOH compliant policies.
Northern Emirates (Non-DHA & Non-DOH Policies):
Vaccine and vaccine administration services are covered according to the table of benefits respective to every policy, please always call NEXtCARE to check if vaccines are covered.
CPT | Description |
90460 | This Code is used when a Physician is present and performs face-to-face counselling to the patient and/or parent. This code can only be used for patients up-to the age of 18. |
90461 | Following each additional vaccine/toxoid component administered , this code is additionally reported along with code 90460 |
90471 | This Code is used when the vaccine/toxoid component is administered by a medical assistant or nurse and the patient does not see the physician at all. |
90472 | Following each additional vaccine/toxoid component administered, this code is additionally reported along with code 90471 |
NEXtCARE coverage of pre-operative tests is based on the ASA classification (Table 1), physical examination findings and surgery grade (minor, intermediate, and major/complex) as classified by the American Association of the Family Physician:
ASA classification | Definition | Examples, including but not limited to |
ASA I | A normal healthy patient | Healthy (age is taken into consideration) |
ASA II | A patient with mild systemic disease | Mild diseases only without substantive functional limitations. Examples include (but not limited to): current smoker, social alcohol drinker, pregnancy, obesity (30 < BMI < 40), well-controlled DM/HTN, mild lung disease like asthma. |
ASA III | A patient with severe systemic _ NEdisease | Substantive functional limitations; One or more moderate to severe diseases. Examples include (but not limited to): poorly controlled DM or HTN, COPD, morbid obesity (BMI ≥40), active hepatitis, alcohol dependence or abuse, implanted pacemaker, moderate reduction of ejection fraction, ESRD undergoing regularly scheduled dialysis, premature infant PCA < 60 weeks, history (>3 months) of MI, CVA, TIA, or CAD/stents. |
SA IV | A patient with severe systemic disease that is a constant threat to life | Examples include (but not limited to): recent (<3months) MI, CVA, TIA, or CAD/stents, ongoing cardiac ischemia or severe valve dysfunction, severe reduction of ejection fraction, sepsis, DIC, ARD or ESRD not undergoing regularly scheduled dialysis |
ASA V | A moribund patient who is not expected to survive without the operation | Examples include (but not limited to): ruptured abdominal/thoracic aneurysm, massive trauma, intracranial bleed with mass effect, ischemic bowel in the face of significant cardiac pathology or multiple organ/system dysfunction |
(https://www.asahq.org/resources/clinical-information/asa-physical-status-classification-system).
Medically justified pre-operative tests, as per the policy terms and conditions of each health insurance plan will be approved only after approval of the in-patient procedure/surgery, if the surgery is not covered, the pre-operative tests also will not be covered. As per the published Guidelines for Preoperative testing by the American College of Cardiology (ACC) and the American Heart Association (AHA), the factors which guide decision making include the surgery specific risks, patient’s cardiovascular risk and functional capacity.(https://www.nice.org.uk/guidance/NG45) B. Revision History ontents/overview-of-preoperative-evaluation-and-preparation-forgynecologic-surgery) Tests are valid for 6 months (provided there have been no interim change in the patient’s condition, if there have been changes kindly submit all the relevant the reports to justify the repetition of the tests). For patients receiving a preoperative evaluation, code first the reason for the encounter from ICD-10-CM code set Z01.810 to Z01.818:
Assign a code for the condition to describe the reason for the surgery as an additional diagnosis to prevent any delays in the approval and to avoid pending of the claim. Example, a patient presents for a preoperative examination for carpal tunnel surgery on the right wrist and has orders from his surgeon for laboratory tests. You would assign diagnosis code Z01.812, as already noted, for the primary diagnosis, and G56.01, “Carpal tunnel syndrome, right upper limb” as the additional diagnosis. Findings related to the preoperative evaluation must be code as well. Basic covered pre-operative tests are:
CPT Description | |
85025 | Blood count; complete (CBC) |
85610 | Prothrombin time |
85732 | Thromboplastin time, partial (PTT) |
86703 | Antibody; HIV-1 and HIV-2 |
86803 | Hepatitis C antibody |
87340 | Hepatitis B |
(https://www.uptodate.com/contents/preoperative-medical-evaluation-of-the-adult-healthy-patient)
Additional pre-operative tests that can be approved according to the member’s comorbidities are listed below:
CPT | Description |
93306 | ECG |
80069 | Kidney function test |
94010 | Lung function tests |
The below tests are covered for maternity pre-operative procedure if not approved in antenatal care:
CPT Description | |
86900 | Blood typing; ABO |
86901 | Blood typing; Rh (D) |
86850 | Antibody screen, RBC, each serum technique |
Low risk procedures/surgeries:
For low risk procedures/surgeries, Preoperative tests are not covered, until and unless medically indicated. Some examples of low risk procedures/surgeries (but not limited to) are below:
References
https://www.aafp.org/afp/2002/1115/p1889.html
https://www.aafp.org/afp/2002/1115/p1889.html
https://www.medscape.com/viewarticle/556255_6
https://www.aafp.org/afp/2000/0715/p387.html
http://ether.stanford.edu/library/cardiac_anesthesia/Cardiology/ACCAHA%20Practice%20Guidelines.pdf
http://japi.org/april2005/U-306.pdf
https://www.sciencedirect.com/science/article/pii/S1555415512001092
http://www.anaesthesia.med.usyd.edu.au/resources/lectures/Preop_JL.html
http://www.diabetologists-abcd.org.uk/JBDS/JBDS_IP_Surgery_Adults_Full.pdf
https://www.sciencedirect.com/science/article/pii/S0001209214010916
https://www.ama-assn.org/sites/default/files/media-browser/public/physicians/cpt/cpt-molecularpathology-tier-2-codes-january-2017.pdf
https://www.modahealth.com/pdfs/reimburse/RPM017.pdf
For Members
For Healthcare Providers
Rejection reason:
For Members:
What is Hemodialysis?
Hemodialysis is a process where a machine filters wastes, salts and fluid from the blood when the kidneys are not healthy to function regularly, for example, kidney failure. It helps in controlling the blood pressure and maintaining the proper balance of fluid and minerals in the body. Hence, improving the quality of life.
Measurement of kidney function provides the information to plan the hemodialysis. Your treating physician measures the kidney function by using ‘estimated Glomerular Filtration Rate’ (eGFR). The calculation of eGFR is based on the creatinine blood level, gender, age and any underlying disease, for example, diabetes.
Hemodialysis is a serious responsibility, where you have to:
What are the Indications?
Hemodialysis is performed in the following conditions:
What are the common risks/complications of Hemodialysis?
Preparation for hemodialysis:
For a planned Hemodialysis, your physician will prepare a permanent access to your blood stream after informed consent form is signed by you. The access provides a mechanism for a small amount of blood to be safely removed from your circulation and then returned to you in order for the hemodialysis process to work. Adequate time should be given for the healing and stabilizing of the access site.
For emergency Hemodialysis, a plastic tube (catheter) may be inserted into a large vein, either in your neck or near your groin. The catheter is temporary.
For Healthcare Providers:
CPT | Description |
90935 | Hemodialysis procedure with single physician evaluation |
90937 | Hemodialysis procedure requiring repeated evaluation(s) |
20.10 | Hemodialysis on outpatient basis per session |
90945 | Peritoneal Dialysis with single physician evaluation |
90947 | Peritoneal Dialysis requiring repeated evaluations with |
14-01 * | Perdiem – Hemodialysis (HD) |
*14-01 Per Diem-Haemodialysis (HD). Daily all-inclusive rate for out-patient hemodialysis in a dialysis centre provided for a patient. Which shall include:
Recommendations:
References:
For Members:
H.Pylori is a Bacterial infection which grows in the stomach and causes mild to severe acidity. If not treated adequately in a timely manner, it can lead to serious conditions like ulcers and stomach cancer. The infection is more common in adults then in children.
The infection can be transferred from person-to-person, through oral-oral or fecal-oral route. If you or a family member is infected with H.Pylori, then chances of acquiring the infection are higher among the family members.
For Healthcare Providers:
Below is the list of CPT codes related to diagnosis and follow-up on H.Pylori Infection:
Laboratory Test | CPT | Clinical Uses |
Urea Breath Test* | 83014
83013 |
H. pylori at least four weeks after the treatment. |
H.pylori stool antigen | 87338 | Medically necessary for testing for active Helicobacter pylori |
Urea breath test, C-14/C-13 | 78267 | Used to follow-up on already diagnosed patients |
H. pylori, blood test | 83009 | Not approved (experimental) |
* Report 83013 for the breath test analysis and 83014 for the isotope administration and sample collection.
Recommendations:
References:
For Members:
Depending on the reason for treatment, the benefits of physical therapy include:
For Healthcare Providers:
Reference:
For Members
What is Maternity?
Table 1: Complication Arising / Developing During Current Pregnancy | |
Complication Arising / Developing During Current Pregnancy | Risk Score |
Unclear Expected Date of Delivery (EDD) | 4 |
Blood group antibodies | 10 |
Positive HEP B C/HIV | 10 |
Distorted Serum HCG/ AFP /UE3 | 10 |
Hypertension | 10 |
Proteinuria without Urinary Tract Infection (UTI) or hypertension | 10 |
Anemia (9 or below) | 8 |
Low platelet count < 120 X 109 | 8 |
Abnormal Glucose Tolerance Test (GTT) | 10 |
Pre term spontaneous ruptured membranes | 10 |
Small for dates / Large for dates | 10 |
Confirmed chickenpox/rubella/parvo infection | 10 |
Polyhydramnios | 10 |
Oligohydramnios | 10 |
Mal-presentation after 36 weeks | 10 |
Obstetric cholestasis | 10 |
Threatened pre-term labor | 8 |
Intrauterine fetal death | 4 |
Dubai (DHA) Policy:
TABLE 2: RISK BOOKING CRITERIA | |
1. CURRENT PREGNANCY | |
Criteria | Score |
Under 15 years | 10 |
Over 40 years at delivery | 8 |
Misuse of illicit substances/alcohol | 10 |
Smoking | 4 |
Body Mass Index (BMI) 40 or over, OR less than 18 | 10 |
Haemoglobinopathy / severe anemia | 10 |
Blood pressure of more than 140/90 at booking | 10 |
Multiple pregnancy (e.g. Twins) | 10 |
History of infertility: conception -spontaneous, Clomid, IVF, Gift, ICSI. | 10 |
Women who request diagnostic testing (i.e. family history of genetic disorder) e.g. amniocentesis, CVS. | 10 |
|
|
2. MEDICAL HISTORY | |
Criteria | Score |
Cardiac Disease | 10 |
Diabetes (existing) | 10 |
Gestational Diabetes during any pregnancy | 4 |
Endocrine (hormonal) problems e.g. Thyroid disease | 8 |
Severe gastrointestinal disease e.g. ulcerative colitis | 10 |
Serious Psychiatric illness (excluding women on SSRI drugs e.g. Prozac and previous postnatal depression) | 10 |
Asthma, taking oral steroids | 10 |
Major kidney disorder / liver disease | 10 |
Detached Retina | 10 |
Fractured Pelvis (be aware for delivery) | 4 |
Autoimmune disease | 10 |
Uterine abnormality / fibroids / pelvic mass / IUCD in situ | 10 |
3. PREVIOUS PREGNANCIES/LABORS /BIRTHS | |
Criteria | Score |
3 or more proven miscarriages/ + mid-trimester | 10 |
Para 7 or more | 10 |
Previous last baby at term of less than 2.5kgs, IUGR, IUD, NND, SB, cerebral palsy | 10 |
Eclampsia or HELLP syndrome, PIH | 5 |
Admission to ITU or HDU (pregnancy related) | 5 |
Rhesus/ABO antibodies | 10 |
Fetal loss after 22 weeks | 10 |
Placental abruption | 10 |
Preterm labor in last pregnancy before 35weeks | 10 |
Previous obstetric cholestasis | 10 |
HIV positive / Syphilis positive | 10 |
Essential hypertension | 10 |
Neurological disease e.g. epilepsy | 10 |
Previous confirmed DVT/ Pulmonary embolism | 10 |
3rd or 4th degree tear (be aware for delivery) | 5 |
Shoulder Dystocia / Previous baby affected by Group B streptococcus –last birth (be aware for delivery) | 5 |
2 or more caesarean sections | 10 |
Post-partum hemorrhage, MRO (aware for delivery) | 5 |
Previous baby with structural abnormality | 10 |
4. SURGICAL HISTORY | |
Criteria | Score |
Anesthetic Problem (be aware) | 5 |
Surgery to cx: cone biopsy/Letz, colposcopy | 10 |
Uterine surgery such as myomectomy | 10 |
Vaginal Surgery (TVI, TOT – be aware for delivery) | 2 |
5. FAMILY HISTORY | |
Criteria | Score |
Diabetes Type 1 and Type 2 – GTT at 28 weeks | 0 |
Abu Dhabi (DOH) Policy:
Down Syndrome screening:
2- Anomaly scan (18-20 weeks)
3- Coverage of new-born
within 30 days of birth under mother’s card for all services. Coverage can be extended to Out-Patient follow ups & visits within 30 days from birth.
4- Neonatal circumcision:
Check your policy.
Routine Antenatal Screening and Care | |
WEEK | Screening |
6-10 WEEKS First Antenatal Visit |
Confirming pregnancy: Pregnancy test
• Rubella susceptibility, HIV, Varicella, Syphilis (RPR, VDRL), Hep B virus, CBC, Vit. D, Haemoglobinopathy screening***, ABO/Rh/Ab screen • Urine analysis • Cervical cancer screening*** • Down Syndrome Screening(as per note 1) • If Chorionic Villus Sampling(CVS)* is medically indicated, this should be done between 11-14 weeks |
16 WEEKS | • Urine analysis – dipstick
• If Amniocentesis*, is medically indicated, this should be done after 16 weeks * • Unsensitized Rh-negative women require RhoGAM |
25 WEEKS
(only for women who never gave birth before) |
• Urine dipstick – Proteinuria
• Rho(D) Immune Globulin(RhoGAM) |
28 WEEKS
|
• Gestational Diabetes Mellitus screening
• Repeat Rh antibody screen • CBC • Urine dipstick- proteinuria • Hepatitis B Ag (if not done previously) • Rho(D) Immune Globulin (RhoGA) |
31 WEEKS
(only for women who never gave birth before) |
• Urine dipstick- proteinuria
|
34 WEEKS
|
• Urine dipstick- proteinuria
• Rho(D) Immune Globulin(RhoGAM) |
36 WEEKS
|
• Gestational Diabetes Mellitus screening
• Repeat Rh antibody screen • CBC • Urine dipstick- proteinuria • Hepatitis B Ag (if not done previously) • Rho(D) Immune Globulin (RhoGA) |
38 WEEKS
|
• Urine dipstick- proteinuria |
40 WEEKS
(only for women who never gave birth before) |
• Urine- proteinuria |
41 WEEKS | • Urine- proteinuria
• Ultrasound • Fetal assessment (ultrasound+ CTG) |
Northern Emirates (Non-DHA & Non-DOH Policies):
Please check your policy for details.
For Healthcare Providers:
LOW RISK ANTENATAL CARE MODEL: | ||
Week: | Investigations: | CPT: |
10-14 weeks |
Initial Ultrasound | 76801 |
Genetic screening (Double or Triple Marker) |
Double test:
76813-84163-84704 Triple test: 82105 – 84704 -82677 Inhibin A: 86336 à Not Covered |
|
CBC, FBC and Platelets | 85025 | |
Blood group, Rhesus status(INDIRECT COOMBS) & antibodies
(if negative, husband blood group and Rh status may be requested) |
86901/86886 | |
VDRL (Syphilis test, non-treponemal antibody; qualitative) | 86592 | |
Urinalysis
Urine culture if any abnormalities in urine analysis. |
81001 – 81000
87088 |
|
Rubella serology | 86762 | |
FBS, random or HbA1c | 82947 | |
HIV | 86703 | |
Hepatitis B – HBsAg | 87340 – 87341 | |
Hepatitis C offered to high risk of hepatitis infection | 86803 | |
GTT if high risk in gestational diabetes member | 82951 | |
Thyroid (TSH): screening only not covered.
Covered if medically necessary only. |
84443 | |
16 weeks | Ultrasound. | 76805 |
18-20 weeks | Detailed anomaly scan | 76811 |
25 weeks |
Ultrasound. | 76805 |
Repeat GTT
GTT if high risk in gestational diabetes member for high risk patient if normal at first visit |
82951 |
|
28 weeks |
Ultrasound: Fetal growth surveillance | 76816 |
FBC and Platelets | 85025 | |
Rhesus antibody screen
If Rhesus negative à give Anti D, one dose(28-30 weeks) |
86901 | |
Fetal non-stress test for high risk pregnancies | 59025 | |
31 weeks | Ultrasound: Fetal growth surveillance | 76816 |
34 weeks | Ultrasound: Fetal growth surveillance | 76816 |
36 weeks | Fetal growth surveillance | 76816 |
If medically necessary à Low vaginal swab for group B hemolytic streptococcus | 87070 | |
38 weeks | Fetal growth surveillance | 76816 |
40 weeks | Fetal growth surveillance | 76816 |
References:
For Members:
For Healthcare Providers:
Recommendations:
# | Specialty | Physician | Provider | ICD | FOB | No. of days | Action Required |
1 | Same | Same | Same | Same | Out-Patient | 7 | Kindly submit History & Details of presenting complaints |
2 | Same | Same | Same | Different | Out-Patient | 7 | Kindly submit details |
3 | Same | Same | Different | Same | Out-Patient | 7 | Please Provide the reason of changing the provider |
4 | Same | Same | Different | Different | Out-Patient | 7 | Please Provide the reason of changing the provider |
5 | Same | Different | Same | Same | Out-Patient | 7 | Please Provide the reason of referral |
6 | Same | Different | Same | Different | Out-Patient | 7 | Can be Approved in accordance to TOB |
References:
https://www.doh.gov.ae/en/resources/standards
https://www.nextcarehealth.com/Media/ViewsDetails?Views_Id=94
For Members
What are the common risks/complications?
For Healthcare Providers
Recommendations:
Covered CPT | Specific Allergy Tests |
82785 | Gamma-globulin (immunoglobulin); IgE
(For total quantitative IgE) |
Not Covered CPTs | Specific Allergy Tests |
86001 | Allergen specific IgG quantitative or semi quantitative |
86003 | Allergen specific IgE; quantitative or semi-quantitative, crude allergen extract |
86005 | Allergen specific IgE; qualitative, multiallergen screen |
References:
For Members:
What are the common risks/complications?
For Healthcare Providers:
Recommendations:
CPT | Description |
93306 | Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography. |
93307 | Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, without spectral or color Doppler echocardiography |
93308 | Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, follow-up or limited study |
References:
For Members:
Fibroscan is a test to measures the amount of thickening or scarring of tissues (fibrosis) in the liver. It is also known as transient electrography. This test assist in aaccurately diagnosing liver tissues abnormalities which helps in determining the stage of the liver disease, assessing the patient’s progress, and predicting treatment responses. Most patients will not show any symptoms. However, some might have fatigue, malaise, or abdominal discomfort on the right upper side. The test can be performed with or without ultrasound.
For Healthcare Providers:
CPT | Description |
91200 | Liver elastography, mechanically induced shear wave (e.g., vibration), without imaging, with interpretation and report |
0346T | Ultrasound, elastography (List separately in addition to code for primary procedure) |
91299 | Unlisted diagnostic gastroenterology procedure |
References:
For Members:
What are the Indications?
Investigate symptoms: An endoscopy may help your doctor determine what’s causing digestive signs and symptoms, such as nausea, vomiting, abdominal pain, difficulty swallowing and gastrointestinal bleeding.
Diagnose: Your doctor may use an endoscopy to collect tissue samples (biopsy) to test for diseases and conditions, such as anaemia, bleeding, inflammation, diarrhea or cancers of the digestive system.
Treat: Your doctor can pass special tools through the endoscope to treat problems in your digestive system, such as burning a bleeding vessel to stop bleeding, widening a narrow oesophagus, clipping off a polyp or removing a foreign object.
For Healthcare Providers:
Recommendations:
CPT |
Clinical Indications for LOWER GI Endoscopy |
45330-45347 |
|
CPT |
Clinical Indications for UPPER GI Endoscopy |
43200 |
|
43235 | |
43237 | |
43238 | |
43239 | |
43242 | |
43259 |
Endoscopy under General Anaesthesia (GA):
Diagnostic and uncomplicated therapeutic upper endoscopy and colonoscopy procedures are usually performed with moderate sedation to relieve patient anxiety and discomfort. Indications to perform Endoscopy under General Anaesthesia (GA) are below:
References:
For Members:
Sometimes hormones get out of balance. This can lead to diseases e.g., diabetes, weight gain or loss, infertility, weak bones, and other problems. A specialist in hormones is called an Endocrinologist, who can help you get your body checked and back in balance, if you have a hormone-related condition.
There are no complications for Hormonal test. It’s a simple test which is conducted on a blood sample.
For Healthcare Providers:
Recommendations:
Laboratory test | CPT | Clinical Usage |
Metanephrines, Normetanephrine, Total Metanephrines |
83835
81050* |
· Metanephrines testing is used to help detect or rule out the presence of a rare tumor called a pheochromocytoma or a paraganglioma that releases excess metanephrines.
· In cases where unknown causes of headaches, heart palpitations or heavy sweating after other initial basic investigations. · Can be approved to diagnose disorders of adrenal gland or to rule out secondary causes of hypertension. · Pheochromocytoma or paraganglioma. · Disorders of adrenal gland or to rule out secondary causes of hypertension. * For additional charge for volume measurement. |
Testosterone; total |
84403 | · Testosterone is an endogenous androgen responsible for normal growth and development of male sex organs/characteristics.
· Rejected in cases of infertility and erectile dysfunction. · Can be approved in cases of menstrual cycle disorder unless related to infertility (polycystic ovarian syndrome (PCOS). · In boys with delayed or slowly progressing puberty, Precocious puberty in young boys. |
Gonadotropin; Follicle Stimulating Hormone (FSH) |
83001 | · FSH is an important part of the reproductive system. It’s responsible for the growth of ovarian follicles
· Menstrual cycle disorders unless related to infertility. · To diagnose disorders of pituitary gland or diseases involving the ovaries. · In children, delayed or precocious (early) puberty. · Infertility in Men, to determine the reason for a low sperm count) |
Prolactin |
84146 | · A prolactin (PRL) test measures the level of prolactin in the blood. Prolactin is a hormone secreted by the pituitary gland
· To diagnose a case of prolactinoma ( a type of tumor of pituitary gland). · In cases of menstrual cycle disorders unless related to infertility · Galactorrhea · In men for decreased libido and/or erectile dysfunction |
Progesterone |
84144 | · Mainly tested in cases of infertility
· In cases of Menstrual cycle disorders unless related to infertility. · High levels of Progesterone is in cases of ovarian cancer, adrenal cancer, congenital adrenal hyperplasia |
Renin |
84244 | · Renin is a protein (enzyme) released by special kidney cells when there is a decreased salt (sodium) level or low blood volume.
· Usually is done at the same time as an aldosterone blood test to calculate the renin-aldosterone ratio. · To know the cause of high blood pressure |
Aldosterone |
82088 | · ALD is a hormone made by the adrenal glands. It affects blood pressure and also regulates sodium (salt) and potassium.
· In cases to diagnose high blood pressure, orthostatic hypotension, overproduction of ALD, adrenal insufficiency · To diagnose fluid and electrolyte disorders caused by heart problems, kidney failure, diabetes insipidus, and adrenal disease. · Primary hyperaldosteronism, Secondary hyperaldosteronism & Adrenal insufficiency. |
Cortisol; free |
82530 | · In cases such as Addison’s disease and Cushing’s disease, which affect the amount of cortisol the adrenal glands produced.
· The test is used in the diagnosis of these diseases and as a way to assess the functioning of the adrenal and pituitary glands. · Cushing syndrome · Adrenal insufficiency · Addison disease |
Adrenocorticotropic hormone (ACTH) |
82024 | · Often done along with a cortisol test to diagnose disorders of the pituitary or adrenal glands:
o Cushing’s syndrome. o Addison disease. o Hypopituitarism. o Pituitary tumors o Acute adrenal crisis |
References:
For Members:
Tumor Markers is a laboratory test to check substances, often proteins that are produced by the cancer tissue itself or sometimes by the body in response to cancer growth. These substances can be detected in body samples such as blood, urine, and tissue, which helps in detecting and diagnosing some types of cancer, predict and monitor a person’s response to certain treatments, and detect recurrence.
There are no complications for Tumor Marker test.
For Healthcare Providers:
Recommendations:
Tumor Marker | CPT | Indications | Details |
Alpha-fetoprotein (AFP) | 82105 | Hepatocellular carcinoma and testicular germ cell tumor. | To diagnose liver cancer and follow response to treatment; to assess stage, prognosis, and response to treatment of testicular tumor. |
Anaplastic Lymphoma Kinase (ALK gene) | 88342 | Lung cancer | To determine treatment and prognosis. |
Cytokeratin fragment | 88342 | Lung cancer | To help in monitoring for recurrence. |
Beta-2-microglobulin (B2M) | 82232 | Multiple myeloma, chronic lymphocytic leukemia, and small lymphoma | To determine prognosis and follow response to treatment. |
Beta-human chorionic gonadotropin (BetahCG) | 84702 | Choriocarcinoma and testicular germ cell tumor | To assess stage, prognosis, response to treatment |
BCR-ABL fusion gene (Philadelphia chromosome) | If P190 transcript expression was previously documented, only P190 BCR-ABL1 will be performed (CPT code(s): 81207). If P210 transcript expression was previously documented, only P210 BCR-ABL1 will be performed (CPT code(s): 81206). If no prior positive is documented, P190 BCR-ABL1 and P210 BCR-ABL1 will be performed (CPT code(s): 81206, 81207 |
Chronic Myeloid Leukemia, Acute Lymphoblastic leukemia, Acute Myelogenous leukemia | To confirm diagnosis, predict response to targeted therapy, monitor disease. |
Bladder Tumor Ag (BTA) | 88120 or 88121- depending on method performed | Bladder cancer, cancer of kidneys and ureters. | Follow up treatment for bladder cancer or, monitoring for eradication of bladder cancer or, recurrences after eradication. |
CA-15-3 / CA27.29 | 86300 | Breast Cancer | For screening (only if clinically indicated), treatment effectiveness or recurrence. |
Estrogen receptor/progesterone receptor | 88360 | Breast Cancer | To determine whether treatment with hormone therapy and some targeted therapies is appropriate. |
CA-125 | 86304 | Ovarian cancer | To help diagnose, response to treatment, recurrence. |
Human Epididymis Protein 4 (HE4) | 86305 | Ovarian cancer | To plan cancer treatment, assess disease progression, and monitor for recurrence but not for screening. |
Carcinoembryonic antigen (CEA) | 82378 | Colorectal cancer | For treatment effectiveness or recurrence. |
Chromogranin A (CgA) | 86316 | Neuroendocrine tumor | To help in diagnosis, assessment of treatment response, and evaluation of recurrence |
References:
For Members:
Pure-tone audiometry is a test to measure the hearing ability and sensitivity. The test is conducted in a soundproof booth and you have to wear special headphones. Different pitches of sound will be played and you will be asked to describe what you can hear. In this test, a Pure Tone Thresholds (PTTs) is checked to indicate the softest sound audible to a person, at-least 50% of the time.
Hearing loss can be Temporary or Permanent and be one sided or both sides (Unilateral and Bilateral).
Insurance Policy:
For Abu Dhabi (DOH), Dubai (DHA) and Northern Emirates Policies, the test is excluded generally with few exceptions. Please always check your policy details.
For Healthcare Providers:
CPT | Description | |
92551 | Screening test, pure tone, air only | |
92552 | Pure tone audiometry (threshold); air only | Cannot be billed in the same day, because these are already included in comprehensive audiometry. |
92553 | Air and bone | |
92555 | Speech audiometry threshold; | |
92556 | With speech recognition | |
92557 | Comprehensive audiometry threshold evaluation and speech recognition (92553 and 92556 combined) |
Recommendations:
References:
For Members:
For Healthcare Providers:
Recommendations:
CPT | Description | Frequency |
95907 | 1-2 nerves | Once per day per patient |
95908 | 3-4 nerves | Once per day per patient |
95909 | 5-6 nerves | Once per day per patient |
95910 | 7-8 nerves | Once per day per patient |
95911 | 9-10 nerves | Once per day per patient |
95912 | 11-12 nerves | Once per day per patient |
95913 | 13 nerves or more | Once per day per patient |
95900 | Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study. | Once only for each nerve even if multiple sites at same nerve tested. |
95903 | Nerve conduction, amplitude and latency/velocity study, each nerve; motor, with F-Wave study. | Once only for each nerve even if multiple sites at same nerve tested. |
95904 | Nerve conduction, amplitude and latency/velocity study, each nerve; Sensory. | Once only for each nerve even if multiple sites at same nerve tested. |
References:
For Members:
For Healthcare Providers:
Recommendations:
CPT | Description |
70544 | Magnetic resonance angiography (MRA), head; without contrast material(s). |
70545 | MRA Without contrast material(s). |
70546 | MRA Without contrast material(s), followed by contrast material(s) and further sequences. |
70551 | Magnetic resonance imaging (MRI) , brain (including brain stem); without contrast material. |
70552 | MRI with contrast material(s). |
70553 | MRI without contrast material, followed by contrast material(s) and further sequences. |
References:
For Members:
For Healthcare Providers:
CPT | Description |
73721 | Magnetic resonance (e.g., proton) imaging, any joint of lower extremity; without contrast material. |
73722 | MRI Without contrast material(s). |
73723 | MRA Without contrast material(s), followed by contrast material(s) and further sequences. |
References:
For Members:
It is an exercise stress test where heart’s electrical activity is checked while you are exercising to estimate the risk of heart diseases. Any abnormalities identified in the electrical activity indicates the presence of heart vessels disease. It is also known as ‘treadmill test’. During the test, the treadmill speed and slope is gradually increased at roughly 3-minute intervals.
It is highly recommended that you should not take heart/chest discomfort medications on the day of your test, unless your doctor advices. The test is performed on empty stomach that is why do not drink or eat anything at-least 4 hours before the test. Consuming caffeine 12 hrs before the test is strictly prohibited.
For Healthcare Providers:
Recommendations:
CPT | Description |
93015 | Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise. |
93016 | Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress: supervision only, without interpretation and report. |
93017 | Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress: tracing only, without interpretation and report. |
93018 | Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress: interpretation and report only. |
References: