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Centers for Medicare & Medicaid Services (CMS) January 15th 2018 Local Coverage Determination (LCD) Updates
Centers for Medicare & Medicaid Services (CMS) Local Coverage Determination (LCD) Updates »
January 15th 2018 Policy Updates:
| DOCUMENT ID | DOCUMENT TITLE |
| A52985 | Acute Care: Inpatient, Observation and Treatment Room Services |
| L36241 | Allergy Testing |
| L35041 | Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds |
| A54117 | Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds |
| A52687 | Billing – Submission of Claims for Compounded Medications for Infusion Pumps for Treatment of Chronic Intractable Pain |
| A52688 | Billing and Coding – Clarification of the Proper Use and Billing of Adenosine Injections |
| A52689 | Billing and Coding – Removal of Impacted Cerumen and Evaluation and Management Services |
| A55352 | Billing and Coding for Rezum® Procedure |
| L35396 | Biomarkers for Oncology |
| A52986 | Biomarkers for Oncology |
| L35062 | Biomarkers Overview |
| L36715 | BRCA1 and BRCA2 Genetic Testing |
| A52375 | Category III CPT® Code Coverage |
| L34370 | Category III CPT® Codes |
| L35006 | Controlled Substance Monitoring and Drugs of Abuse Testing |
| L36393 | Controlled Substance Monitoring and Drugs of Abuse Testing |
| A55878 | Controlled substance monitoring and drugs of abuse testing revision to the Part A and Part B LCD |
| A52690 | Drugs and Biologicals – Ziconotide Intrathecal Infusion (Prialt ®) (J2278) |
| L34253 | Drugs and Biologicals: Botulinum Toxins |
| L34254 | Drugs and Biologicals: Colony Stimulating Factors |
| L34256 | Drugs and Biologicals: Immune Globulin Intravenous (IVIg) |
| L34257 | Drugs and Biologicals: Infliximab (REMICADE ®) |
| L34258 | Drugs and Biologicals: Octreotide Acetate for Injectable Suspension (Sandostatin LAR ® Depot) |
| L34258 | Drugs and Biologicals: Octreotide Acetate for Injectable Suspension (Sandostatin LAR ® Depot) |
| L34260 | Drugs and Biologicals: Zoledronic Acid |
| A52693 | Educational Article – CPT 0171T and 0172T (Insertion of posterior spinous process distraction device) |
| A52694 | Educational Article – Gastric Restrictive Procedures and Subsequent Visits |
| A52695 | Educational Article – Guidelines for the Use of “Scribes” in Medical Record Documentation |
| A52696 | Educational Article – Pulmonary Rehabilitation (PR) Services |
| A53124 | Endovascular Repair of Aortic and/or Iliac Aneurysms |
| L36920 | Epidural Injections for Pain Management |
| L35111 | Hemophilia Factor Products |
| L35427 | Hyaluronan Acid Therapies for Osteoarthritis of the Knee |
| A55036 | Hyaluronan Acid Therapies for Osteoarthritis of the Knee |
| L35448 | Independent Diagnostic Testing Facility (IDTF) |
| A53252 | Independent Diagnostic Testing Facility (IDTF) |
| A55287 | LCD – Comment/Response – Medicine: Home Sleep Testing (HST) (L36745) |
| A55303 | LCD – Comment/Response – Pathology and Laboratory: BRCA1 and BRCA2 Genetic Testing (L36741) |
| A55015 | LCD – Comment/Response – Pathology and Laboratory: KRAS Testing prior to Treatment of Colorectal Cancer (CRC) (L36582) |
| A55309 | LCD – Comment/Response – Radiology: Intensity Modulated Radiotherapy (IMRT) (L36743) |
| A55733 | Local Coverage Article: Ventricular Assist Device (VAD) Supply or Accessory (A55733) |
| A55733 | Local Coverage Article: Ventricular Assist Device (VAD) Supply or Accessory (A55733) |
| L34500 | Medicine: Autonomic Function Tests |
| L36945 | Medicine: Bioimpedance Spectroscopy (BIS) Devices for the Detection and Management of Lymphedema |
| L36945 | Medicine: Bioimpedance Spectroscopy (BIS) Devices for the Detection and Management of Lymphedema |
| L34262 | Medicine: Health and Behavior Assessment/Intervention |
| L36745 | Medicine: Home Sleep Testing (HST) |
| L36745 | Medicine: Home Sleep Testing (HST) |
| L34263 | Medicine: Hydration Therapy |
| L34263 | Medicine: Hydration Therapy |
| L34264 | Medicine: Long-Term Wearable Electrocardiographic Monitoring (WEM) |
| L34265 | Medicine: Nerve Conduction Studies (NCS) and Electromyography (EMG) |
| L34266 | Medicine: Neurophysiology Evoked Potentials (NEPs) |
| L34267 | Medicine: Noninvasive Peripheral Arterial and Venous Studies |
| L35941 | Medicine: Psychotherapy Services |
| L34269 | Medicine: Repetitive Transcranial Magnetic Stimulation (rTMS) for Resistant Depression |
| L34270 | Medicine: Wireless Capsule Imaging |
| L34270 | Medicine: Wireless Capsule Imaging |
| L37305 | MolDX: Oncotype DX® Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer |
| L37321 | MolDX: Oncotype DX® Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer |
| L35000 | Molecular Pathology Procedures |
| L35049 | Monitored Anesthesia Care |
| A52698 | NCD – Pharmacogenomic Testing for Warfarin Response |
| A52698 | NCD – Pharmacogenomic Testing for Warfarin Response |
| A52699 | NCD – Sterilization |
| A53134 | NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions |
| A53132 | NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Oncologic Conditions |
| L35456 | Nerve Blockade for Treatment of Chronic Pain and Neuropathy |
| L35457 | Nerve Blockade for Treatment of Chronic Pain and Neuropathy |
| L34975 | Neurophysiology Evoked Potentials (NEPs) |
| L33777 | Noncovered Services |
| A55880 | Noncovered services (procedure codes 0449T and 0450T) – revision to the Part A and Part B local coverage article |
| L35409 | Non-Vascular Extremity Ultrasound |
| A55037 | Non-Vascular Extremity Ultrasound |
| L36741 | Pathology and Laboratory: BRCA1 and BRCA2 Genetic Testing |
| L36741 | Pathology and Laboratory: BRCA1 and BRCA2 Genetic Testing |
| L34271 | Pathology and Laboratory: B-type Natriuretic Peptide (BNP) Testing |
| L34273 | Pathology and Laboratory: Circulating Tumor Cells (CTC) Assays |
| L34273 | Pathology and Laboratory: Circulating Tumor Cells (CTC) Assays |
| L34272 | Pathology and Laboratory: C-Reactive Protein; High Sensitivity (hsCRP) |
| L34272 | Pathology and Laboratory: C-Reactive Protein; High Sensitivity (hsCRP) |
| L35660 | Pathology and Laboratory: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing |
| L35660 | Pathology and Laboratory: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing |
| L35553 | Pathology and Laboratory: Genetic Testing for Lynch Syndrome |
| L35553 | Pathology and Laboratory: Genetic Testing for Lynch Syndrome |
| L36582 | Pathology and Laboratory: K-ras Testing prior to Treatment of Colorectal Cancer (CRC) |
| L34943 | Pathology and Laboratory: Molecular Pathology Procedures for Human Leukocyte Antigen (HLA) Typing |
| L34943 | Pathology and Laboratory: Molecular Pathology Procedures for Human Leukocyte Antigen (HLA) Typing |
| L36444 | Pathology and Laboratory: Molecular RBC Phenotype |
| L36444 | Pathology and Laboratory: Molecular RBC Phenotype |
| L36446 | Pathology and Laboratory: Partial Genome Profiling in Non Small Cell Lung Cancer (NSCLC) |
| L36446 | Pathology and Laboratory: Partial Genome Profiling in Non Small Cell Lung Cancer (NSCLC) |
| L34501 | Pathology and Laboratory: Qualitative Drug Testing |
| L35920 | Pathology and Laboratory: Quantitative Drug Testing |
| L35920 | Pathology and Laboratory: Quantitative Drug Testing |
| L34274 | Pathology and Laboratory: Vitamin D Assay Testing |
| L34274 | Pathology and Laboratory: Vitamin D Assay Testing |
| L35679 | Pharmacokinetic (PK) Testing for Chemotherapy Dosing |
| L34275 | Radiology: Computed Tomographic (CT) Colonography |
| L34276 | Radiology: Computed Tomographic Angiography of the Heart and Coronary Vessels |
| L34277 | Radiology: Computed Tomography of the Abdomen and Pelvis |
| L36743 | Radiology: Intensity Modulated Radiation Therapy (IMRT) |
| L34278 | Radiology: Magnetic Resonance Imaging of the Brain |
| L34278 | Radiology: Magnetic Resonance Imaging of the Brain |
| L34279 | Radiology: Myocardial Perfusion Imaging (MPI) |
| L34279 | Radiology: Myocardial Perfusion Imaging (MPI) |
| L34282 | Radiology: Proton Beam Therapy |
| L34283 | Radiology: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT) |
| L34938 | Removal of Benign Skin Lesions |
| A55839 | Response to Comments: MolDX: Oncotype DX® Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer |
| A55840 | Response to Comments: MolDX: Oncotype DX® Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer |
| A55009 | Response to Comments: Surgery: Implantable Pacemakers with Leads for Cardiac Rate, Dysrhythmia, Resynchronization, and Cardioversion/ Defibrillation (PM CRT AICD) (L36584) |
| A53127 | Self-Administered Drug Exclusion List |
| A52700 | Self-Administered Drug Exclusion List – JJ MAC |
| L35094 | Services That Are Not Reasonable and Necessary |
| A54949 | Single Chamber and Dual Chamber Permanent Cardiac Pacemakers – Coding and Billing |
| A52928 | Sources of Information and Basis for Decision Noncovered Services LCD |
| L35070 | Speech – Language Pathology (SLP) Services: Communication Disorders |
| A54111 | Speech Language Pathology (SLP) Services: Communication Disorders |
| L34285 | Surgery: Bioengineered Skin Substitutes (BSS) for the Treatment of Diabetic and Venous Stasis Ulcers of the Lower Extremities |
| L34286 | Surgery: Blepharoplasty |
| L34286 | Surgery: Blepharoplasty |
| L34288 | Surgery: Colonoscopy (Diagnostic) |
| L34289 | Surgery: Continuous Peripheral Nerve Blocks (CPNB) |
| L34290 | Surgery: Debridement Services |
| L34290 | Surgery: Debridement Services |
| L35942 | Surgery: Fusion for Degenerative Joint Disease of the Lumbar Spine |
| L35658 | Surgery: Implantable Hormone Pellets |
| L34291 | Surgery: Injections of the Spinal Canal |
| L34291 | Surgery: Injections of the Spinal Canal |
| L34292 | Surgery: Interventional Renal Denervation (IRD) for Resistant Hypertension |
| L34292 | Surgery: Interventional Renal Denervation (IRD) for Resistant Hypertension |
| L36084 | Surgery: Leadless Cardiac Pacemaker |
| L36084 | Surgery: Leadless Cardiac Pacemaker |
| L35889 | Surgery: Left Atrial Appendage |
| L34293 | Surgery: Lumbar Facet Blockade |
| L34294 | Surgery: Major Joint Replacement (Hip and Knee) |
| L34294 | Surgery: Major Joint Replacement (Hip and Knee) |
| L34295 | Surgery: Nerve Blocks and Electrostimulation for Peripheral Neuropathy |
| L34296 | Surgery: Posterior Tibial Nerve Stimulation (PTNS) for Urinary Control |
| L35554 | Surgery: Reduction Mammaplasty |
| L35554 | Surgery: Reduction Mammaplasty |
| L34944 | Surgery: Routine Foot Care |
| L36879 | Surgery: Spinal Cord Stimulators for Chronic Pain |
| L34298 | Surgery: Transoral Incisionless Fundoplication (TIF) |
| L34300 | Surgery: Vertebral Augmentation Procedures (VAPs) |
| L34300 | Surgery: Vertebral Augmentation Procedures (VAPs) |
| L34301 | Surgery: YAG Capsulotomy |
| L35036 | Therapy and Rehabilitation Services (PT, OT) |
| L34302 | Transportation Services: Ambulance |
| L34302 | Transportation Services: Ambulance |
| L34924 | Treatment of Varicose Veins and Venous Stasis Disease of the Lower Extremities |
| A55229 | Treatment of Varicose Veins and Venous Stasis Disease of the Lower Extremitie |
Centers for Medicare & Medicaid Services (CMS) Local Coverage Determination (LCD) Updates »
Policy Alerts monitors Commercial and Medicare medical policies for changes. While Payers typically update medical policies annually, there are many reasons why a Payer might review or update a policy. When reviews occur out of cycle, they may go unnoticed. Policy Alerts keeps you informed of upcoming and unexpected coverage changes affecting your product. Quickly understanding the changes Payers make can help you adjust reimbursement strategies impacting your business.
Policy Alerts continuously monitors Commercial and Medicare Payer coverage information to keep you up-to-date on Payer decisions in real-time. Whenever changes occur, email notifications containing a summary of those changes are delivered to your inbox. Clients can access detailed coverage reports and medical policies on the interactive Dashboard portal. Save time and keep focused on the important Payer medical policy reviews and coverage decisions affecting your product!
Policy Alerts takes a client-focused hands-on approach and works hard to provide our customers with helpful insights and actionable analytics over raw data. We understand what our clients need and we are dedicated to making sure we provide timely, accurate and always up-to-date reports that can be used to implement and support a successful reimbursement strategy.
Health economic and reimbursement information provided by Policy Alerts is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules and policies. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice.
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