Hepatitis Panel/Acute Hepatitis Panel National Coverage ...

Medicare Limited Coverage Tests Covered Diagnosis Codes Source: National Coverage Determinations Coding Policy Manual and Change Report (ICD-10-CM) July 2015 Effective October 1, 2015 Medicare Limited Coverage Tests Hepatitis Panel /Acute Hepatitis Panel National Coverage Determination CPT Code: 80074 Code Description Hepatitis A with hepatic coma Hepatitis A without hepatic coma Acute Hepatitis B with delta-agent with hepatic coma Acute Hepatitis B with delta-agent without hepatic coma Acute Hepatitis B without delta-agent with hepatic coma Acute Hepatitis B without delta-agent and without hepatic coma Acute delta-(super) infection of Hepatitis B carrier Acute Hepatitis C without hepatic coma Acute Hepatitis C with hepatic coma Acute Hepatitis E Other specified acute viral Hepatitis Acute viral Hepatitis , unspecified Chronic viral Hepatitis B with delta-agent Chronic viral Hepatitis B without delta-agent Chronic viral Hepatitis C Other chronic viral Hepatitis Chronic viral Hepatitis , unspecified Unspecified viral Hepatitis with hepatic coma Unspecified viral Hepatitis B without hepatic coma Unspecified viral Hepatitis B with hepatic coma Unspecified viral Hepatitis C without hepatic coma Unspecified viral Hepatitis C with hepatic coma Unspecified viral Hepatitis without hepatic coma Postviral fatigue syndrome Esophag

I85.00 Esophageal varices without bleeding I85.01 Esophageal varices with bleeding I85.10 Secondary esophageal varices without bleeding I85.11 Secondary esophageal varices with bleeding K70.41 Alcoholic hepatic failure with coma K71.0 Toxic liver disease with cholestasis K71.10 Toxic liver disease with hepatic necrosis, without coma

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