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Centers for Medicare & Medicaid Services (CMS) February 4th 2018 Local Coverage Determination (LCD) Updates

Centers For Medicare & Medicaid Services (CMS) February 4th 2018 Local Coverage Determination (LCD) Updates
Centers for Medicare & Medicaid Services (CMS) Local Coverage Determination (LCD) Updates

Centers for Medicare & Medicaid Services (CMS) Local Coverage Determination (LCD) Updates »

February 4th 2018 LCD Updates:

  • A55667 (retired)        Response to Comments: Cosmetic and Reconstructive Surgery
  • A55896           Destruction of Paravertebral Facet Joint Nerve(s) Coding Guideline
  • A55895           Ambulatory surgical center (ASC) inappropriate use of modifier 50
  • A55894           Destruction of paravertebral facet joint nerve(s) clarification of article /revision to the Part B LCD/“Coding Guideline” article
  • L33767            Viscosupplementation Therapy For Knee
  • L34960            Hydration Therapy
  • L33774            Wireless Capsule Endoscopy
  • L33771            Vitamin D; 25 hydroxy, includes fraction(s), if performed
  • L33410            Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)
  • L36035            Spinal Cord Stimulation for Chronic Pain
  • L34021            Sedimentation Rate, Erythrocyte
  • L33538            Radiation Therapy for T1 Basal Cell and Squamous Cell Carcinomas of the Skin
  • L34912            Genetic Testing for Lynch Syndrome
  • L33726            Gemcitabine (Gemzar®)
  • L33661            Flow Cytometry
  • L36276            Erythropoiesis Stimulating Agents
  • L33669            Electrocardiography
  • L33274            Botulinum Toxins
  • L33273            Bortezomib (Velcade®)
  • L36356            Bone Mineral Density Studies
  • L33270            Bisphosphonates (Intravenous [IV]) and Monoclonal Antibodies in the Treatment of Osteoporosis and Their Other Indications
  • L33967            Vitamin B 12 Injections
  • L33963            Tympanometry
  • L33941            Routine Foot Care
  • L33810            Computerized Corneal Topography
  • L33804            Allergen Immunotherapy
  • A55852           Response to Comments: Vitamin D Assay Testing
  • L33939            Reduction Mammaplasty
  • A55891           Reduction mammaplasty revision to the Part B LCD
  • A55889           Multiple Part A/B and Part B local coverage determination revisions
  • L37535            Vitamin D Assay Testing
  • A55848           Response to Comments: Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Essential Tremor
  • L37421            Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Essential Tremor
  • L36711            Intensity Modulated Radiation Therapy (IMRT)
  • L35006            Controlled Substance Monitoring and Drugs of Abuse Testing
  • L34422            Infrared Coagulation (IRC) of Hemorrhoids
  • L34574            Dental Services
  • L34410            B-type Natriuretic Peptide (BNP) Testing
  • L35099            Frequency of Laboratory Tests
  • L35093            Intravenous Immune Globulin (IVIG)
  • L35047            Oral Maxillofacial Prosthesis
  • L34585            Chiropractic Services
  • A55681           Additional Information Required for Coverage and Pricing for Category III CPT® Codes
  • A55607           Additional Information Required for Coverage and Pricing for Category III CPT® Codes
  • L35008            Non-Covered Services
  • L36219            Non-Covered Services
  • L37539            MolDX: Prometheus IBD sgi Diagnostic Policy
  • A55161           MolDX: FDA-Approved BRAF Tests
  • A53784           The Routine Costs of Investigational Chemotherapy Drugs Studied In a Qualifying Clinical Trial
  • A53778           Infusion, Injection and Hydration Services
  • A54735           Billing Requirements for PET Scan Claims to Identify Bone Metastasis of Cancer
  • A53988           Percutaneous Ventricular Assist Device
  • A54812           Antibacterial Drugs
  • A53781           Spiracur SNaP® Wound Care System
  • A53698           MolDX: SLCO1B1 Genotype Coding and Billing Guidelines
  • A53567           MolDX: PTCH1 Gene Testing Coding and Billing Guidelines
  • A53587           MolDX: RPS19 Gene Tests Coding and Billing Guidelines
  • A53702           MolDX: SEPT9 Gene Test Coding and Billing Guidelines
  • A53624           MolDX: SMPD1 Genetic Testing Coding and Billing Guidelines
  • A53591           MolDX: TP53 Gene Test Coding and Billing Guidelines
  • A54832           Short Tandem Repeat (STR) Markers and Chimerism (codes 81265-81268) Coding and Billing Guidelines
  • A53548           MolDX: VEGFR2 Tests Coding and Billing Guidelines
  • A55071           Once in a Lifetime Abdominal Aortic Aneurysm (AAA) Screening Article
  • A53593           MolDX: UGT1A1 Gene Analysis Coding and Billing Guidelines
  • A54831           Single Chamber and Dual Chamber Permanent Cardiac Pacemakers – Coding and Billing
  • A53562           MolDX: STAT3 Gene Testing Coding and Billing Guidelines
  • A53538           MolDX: SULT4A1 Genetic Testing Coding and Billing Guidelines
  • A55822           MolDX: ThermoFisher Oncomine Dx Target Test For Non-Small Cell Lung Cancer, Coding and Billing Guidelines
  • A53589           MolDX: TERC Gene Tests Coding and Billing Guidelines
  • A53664           MolDX: PAX6 Gene Sequencing Coding and Billing Guidelines
  • A53558           MolDX: PIK3CA Gene Tests Coding and Billing Guidelines
  • A53489           MolDX: PreDx® Coding and Billing Guidelines
  • A53630           MolDX: MCOLN1 Genetic Testing Coding and Billing Guidelines
  • A53468           MolDX: LPA-Intron 25 Genotype Coding and Billing Guidelines
  • A53574           MolDX: MECP2 Genetic Testing Coding and Billing Guidelines
  • A53669           MolDX: Mitochondrial Nuclear Gene Tests Coding and Billing Guidelines
  • A53480           MolDX: HTTLPR Gene Testing Coding and Billing Guidelines
  • A53467           MolDX: LPA-Aspirin Genotype Coding and Billing Guidelines
  • A53493           MolDX: HBB Gene Tests Coding and Billing Guidelines
  • A53598           MolDX: HEXA Gene Analysis Coding and Billing Guidelines
  • A53576           MolDX: KIF6 Genotype Billing and Coding Guidelines
  • A53659           MolDX: L1CAM Gene Sequencing Coding and Billing Guidelines
  • A53554           MolDX: know error® Billing and Coding Guidelines Update
  • A53585           MolDX: NSD1 Gene Tests Coding and Billing Guidelines
  • A53544           MolDX: myPap™ Coding and Billing Guidelines
  • A54795           MolDX: Next Generation Sequencing Coding and Billing Guidelines
  • A53596           MolDX: IKBKAP Genetic Testing Coding and Billing Guidelines
  • A54035           MolDX: MMACHC Test Coding and Billing Guidelines
  • A53638           MolDX: Fragile X Coding and Billing Guidelines Update
  • A53542           MolDX: GBA Genetic Testing Coding and Billing Guidelines
  • A53619           MolDX: HAX1 Gene Sequencing Coding and Billing Guidelines
  • A53565           MolDX: CHD7 Gene Analysis Coding and Billing Guidelines
  • A53524           MolDX: CYP2C9 and/or VKORC1 Gene Testing for Warfarin Response Coding and Billing Guidelines
  • A53602           MolDX: Aspartoacyclase 2 Deficiency(ASPA) Testing Coding and Billing Guidelines
  • A53536           MolDX: ENG and ACVRL1 Gene Tests Coding and Billing Guidelines
  • A53628           MolDX: FANCC Genetic Testing Coding and Billing Guidelines
  • A53556           MolDX: CYP2B6 Test Coding and Billing Guidelines
  • A53615           MolDX: CFTR Gene Analysis Coding and Billing Guidelines
  • A53600           MolDX: BCKDHB Gene Test Coding and Billing Guidelines
  • A53550           MolDX: ATP7B Gene Tests Coding and Billing Guidelines
  • A53484           MolDX: BluePrint® Coding and Billing Guidelines
  • A53540           MolDX: BLM Gene Analysis Coding and Billing Guidelines
  • A53457           MolDX: 4q25-AF Risk Genotype Coding and Billing Guidelines
  • A55310           Billing and Coding Instructions for Lemtrada® (alemtuzumab) When Used in the Treatment of Relapsing Multiple Sclerosis
  • A53652           MolDX: ApoE Genotype Coding and Billing Guidelines
  • A53657           MolDX: 9p21 Genotype Test Coding and Billing Guideline
  • A53779           Kyprolis® (Carfilzomib) Coding and Billing Guidelines and Indications
  • A54769           Influenza Diagnostic Tests
  • A55816           IDTFs and Low Dose CT Scan for Lung Cancer Screening for HCPCS Code G0297
  • A53793           Gender Reassignment Services for Gender Dysphoria
  • A53777           Herceptin (trastuzumab): Coverage and Billing
  • A54835           CDH1 Genetic Testing Coding and Billing Guidelines
  • A55709           Coenzyme Q10 (Q10) Coding and Billing Guideline
  • A54880           Additional Claim Documentation Requirements for Not Otherwise Classified (NOC) Drugs and Biological Products with Specific FDA Label Indications
  • A55804           Billing Requirements for Onivyde® (Irinotecan liposome) J9205
  • A55297           Billing and Coding of Drug and Biological Infusions
  • A53435           Thermal Capsulorrhaphy
  • A53488           Radiology Services: Multiple, Identical Services on Same Day
  • A53452           Sacroiliac-Bone Implant System
  • A53472           Pre/Postoperative Care: Date of Service
  • A53482           Repeat or Duplicate Services on the Same Day
  • A53430           Videostroboscopy and Nasopharyngoscopy Procedures Performed by Speech-Language Pathologists (SLPs)
  • A54559           Xofigo Billing Instructions
  • A53423           Repeat X-ray or EKG Interpretations by Same or Different Physician
  • A53444           Periodic Adjustment of Gastric Restrictive Device after the Global Period: Coding and Billing Instructions
  • A53419           Neuromodulation for Fecal Incontinence
  • A53446           Oral Surgery and Maxillofacial Surgery Specialty Codes
  • A53986           Percutaneous Ventricular Assist Device
  • A54555           Low frequency, non-contact, non-thermal ultrasound (CPT code 97610)
  • A54767           Medicare Preventive Coverage for Certain Vaccines
  • A53708           Coding and Billing External Components for Cochlear Implants
  • A53432           Anesthetic ‘Caine Drugs’
  • A53441           Amniotic Membrane Billing Guidelines for HCPCS Code V2790
  • A53044           ArgusM II Retinal Prosthesis System
  • A53426           FDA Approved Ramucirumab (Cyramza)®
  • A53408           Coverage for High Resolution Anoscopy
  • A53399           CPT Modifier 59: Gastroenterology
  • A53931           Fracture of Ribs with Internal Fixation
  • A53495           Glaucoma Screening
  • A53501           Implantable Miniature Telescope (IMT) for Macular Degeneration
  • A53414           Intraoperative Radiation Therapy (IOERT)
  • A53043           Endometrial Hyperplasia Treatment
  • A53006           Hemorrhoid Artery Ligation CPT Code 0249T Article
  • A54750           FDA approves Iluvien for Diabetic Macular Edema
  • A53387           Aflibercept (Eylea) Coding and Billing Guidelines
  • A53698           MolDX: SLCO1B1 Genotype Coding and Billing Guidelines
  • A54424           MolDX: FDA-Approved EGFR Tests Billing and Coding Guidelines
  • A54422           MolDX: FDA-Approved EGFR Tests Billing and Coding Guidelines
  • A55117           MolDX: CFTR Gene Analysis Billing and Coding Guidelines
  • A55118           MolDX: CFTR Gene Analysis Billing and Coding Guidelines
  • L36902            Polysomnography and Other Sleep Studies
  • L34005            Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy
  • L37254            Chiropractic Services
  • A55888           MolDX: ThermoFisher Oncomine Dx Target Test For Non-Small Cell Lung Cancer Billing and Coding Guidelines
  • L33945            Cerumen (Earwax) Removal
  • L33960            Cardiovascular Nuclear Medicine
  • A55881           MolDX: ThermoFisher Oncomine Dx Target Test For Non-Small Cell Lung Cancer Billing and Coding Guidelines
  • L36975            Bladder/Urothelial Tumor Markers
  • A52382           Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy – Supplemental Instructions Article
  • A52383           Corneal Pachymetry – Supplemental Instructions Article
  • L34062            Dialysis Access Maintenance
  • L34032            Debridement Services
  • L34008            Computerized Corneal Topography
  • L33999            Corneal Pachymetry
  • A54500           MolDX: FDA-Approved KRAS Tests
  • A54498           MolDX: FDA-Approved KRAS Tests
  • A54419 (retired)        MolDX: FDA-Approved BRAF Tests Billing and Coding Guidelines
  • A54417 (retired)        MolDX: FDA-Approved BRAF Tests Billing and Coding Guidelines
  • A53493           MolDX: HBB Gene Tests Coding and Billing Guidelines
  • A53053           CPT Code 97755 – Assistive Technology Assessment

 

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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