Remote monitoring setup, education, data analyses — some entries Always Investigational

Remote monitoring device set-up, patient education, data analyses and 30‑day reports are described; several remote monitoring entries (for example OCT remote image capture and remote surveillance reports, 0607T/0608T/0604T) are marked Always Investigational in the policy.

• 0607T: review, interpretation and report of remote surveillance center data analyses, each 30 days — ExceptionsNotes = Always Investigational
• 0608T: initial device provision, set-up and patient education on use — ExceptionsNotes = Always Investigational
• 0604T: remote monitoring set-up and patient education for external continuous pulmonary fluid monitoring system — ExceptionsNotes = Always Investigational

Device programming/evaluation (remote) — investigational items noted

Programming device evaluation (remote) of cardiac rhythm monitoring systems, with iterative adjustment services, is listed; the policy notes investigational status for some device programming/evaluation items.

• Programming device evaluation (remote) of subcutaneous cardiac rhythm monitor system with iterative adjustment — listed in service descriptions; investigational status noted for some items

Peri‑procedural device evaluation and programming — in‑person

Peri‑procedural in‑person device evaluation and programming before or after a surgery/procedure/test (including analysis, review, and report by a physician or qualified professional) is described for permanent implantable synchronized diaphragmatic stimulation systems.

• Peri‑procedural device evaluation (in‑person) and programming of device system parameters with physician analysis, review, and report — service description present (0683T referenced)

Remote pulmonary artery pressure sensor monitoring — reports and interpretation

Remote monitoring of a wireless pulmonary artery pressure sensor is described for up to 30 days including at least weekly downloads, interpretation, trend analysis, and reporting by a physician or qualified health care professional.

• Remote pulmonary artery pressure sensor monitoring: measurement, transmission, analysis, and report to physician or other qualified health care professional (up to 30 days described in related remote monitoring entries)

Code listings include investigational designations (e.g., 0774T, Q4143 series)

The policy lists numerous codes (for example 0774T, 0776T, 0778T and many Q/A codes) with inline coverage designations; many of these listed codes are annotated as Always Investigational.

• Examples: 0774T, 0776T, 0778T shown in service listings
• Multiple Q‑codes (e.g., Q4143–Q4160 series) listed with ExceptionsNotes = Always Investigational

'Always Investigational' designation implies noncoverage — PA will not make payable

Moda labels many listed codes and services as 'Always Investigational', which the document indicates are considered investigational and therefore not covered — prior authorization would not render these payable.

• 'Always Investigational' entries indicate the payer considers the service investigational and not covered; claims billed with these codes should be expected to be denied regardless of prior authorization

Investigational code listings — many entries flagged Always Investigational

This segment enumerates many specific services and codes (for example 0403U, 0519U, Q4334–Q4337, A2027/A2028) with coverage designations; a large portion are noted as Always Investigational.

• 0403U (oncology prostate mRNA 18‑gene urine profiling) is listed in the service descriptions
• 0519U and multiple Q/A product codes appear with Always Investigational noted for many entries

Investigational designation listing — many codes shown without PA details

The document enumerates numerous tests and procedures designated Always Investigational; these listings do not provide prior authorization workflows or PA requirements in the cited chunks.

• Multiple molecular and genomic tests (cell‑free DNA, ctDNA panels, large NGS panels) and proprietary assays are listed as Always Investigational without PA instructions

Investigational code list (partial) — expect denials if billed

The partial investigational code list explicitly marks numerous CPT/HCPCS and temporary codes as Always Investigational; providers submitting these codes should expect investigational denials per the policy.

• Examples in this chunk: 0565U, 0566U, 0568U, 0957T are annotated Always Investigational
• Policy language ties Always Investigational to noncoverage for the listed codes

Skin substitute application codes (G0681–G0684) — listed; many entries Always Investigational

G0681–G0684 (application of non‑sheet form HCT/P skin substitutes) are listed with service descriptions and Moda marks many related entries in this segment as Always Investigational; billing uses specified wound surface area increments.

• G0681: non‑sheet HCT/P skin substitute up to 100 sq cm; first 25 sq cm or less — listed (Always Investigational noted in segment)
• G0682: each additional 25 sq cm — billing as add‑on
• G0683/G0684: larger wound surface area increments (first 100 sq cm and each additional 100 sq cm) — designated Always Investigational in these chunks

Investigational code designation — no PA workflows specified; likely denials

Many codes in the document are labeled 'Always Investigational,' indicating noncoverage; the policy does not define prior authorization pathways or provider documentation requirements for these investigational entries in the cited chunks.

• Providers should treat codes annotated 'Always Investigational' as not covered and anticipate denials if billed
• No prior authorization workflow or documentation guidance is provided for these entries in the cited sections

Sample investigational T‑codes (0453T–0456T) — Always Investigational

The policy lists sample investigational procedure codes (for example 0453T–0456T range) and marks them Always Investigational in the excerpt.

• 0453T, 0454T, 0456T: endovascular aortic counterpulsation ventricular assist system entries — ExceptionsNotes = Always Investigational

Cosmetic procedure codes (dermabrasion/chemical peel/etc.) — Always Cosmetic

The policy enumerates multiple aesthetic procedure codes (dermabrasion, chemical peel, blepharoplasty, rhytidectomy) that are designated Always Cosmetic and therefore not covered for medical necessity.

• 15781–15789 and related codes: dermabrasion and chemical peel codes annotated Always Cosmetic

Investigational/coverage status listings — many codes marked investigational; no PA steps provided

This portion of the document lists many services (CPT/HCPCS/Q/S codes) marked Always Investigational or other exceptions, and does not provide explicit prior authorization instructions in the cited chunks.

• Numerous codes across categories are shown with ExceptionsNotes = Always Investigational; no PA instructions are included in these entries

Investigational Q‑codes — many wound/biologic products marked Always Investigational

A wide range of HCPCS Q‑codes for biologic/skin/amniotic/wound products (for example Q4143–Q4160 series) are listed with ExceptionsNotes = Always Investigational in the policy.

• Q4143 (Repriza), Q4146 (Tensix), Q4147 (Architect series), Q4148 (Neox 1k), Q4149 (Excellagen) — all annotated Always Investigational

Investigational Q‑ and S‑codes — additional examples marked Always Investigational

Additional HCPCS Q‑ and S‑codes (for example Q4212, Q4226 and multiple S‑codes such as S2348, S3650, S8948) are enumerated and designated Always Investigational in the cited sections.

• Q4212, Q4226 and multiple other Q‑codes: listed with ExceptionsNotes = Always Investigational
• S2348, S3650, S3652, S8948, S9090 and other S‑codes: designated Always Investigational