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Centers for Medicare & Medicaid Services (CMS) November 2017 Local Coverage Determination (LCD) Updates
Centers for Medicare & Medicaid Services (CMS) Local Coverage Determination (LCD) Updates »
November 5th 2017 updates:
| DOCUMENT ID | DOCUMENT TITLE | CONTRACTOR | LAST UPDATED | |
| L33982 (retired) | Chiropractic Services | CGS Administrators, LLC | 11/5/2017 | |
| L36954 | Noncovered Services other than CPT® Category III Noncovered Services | Palmetto GBA | 11/3/2017 | |
| L34555 | Non-Covered Category III CPT Codes | Palmetto GBA | 11/3/2017 | |
| L35677 | Infliximab | Palmetto GBA | 11/3/2017 | |
| L36471 | Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy | Palmetto GBA | 11/3/2017 | |
| L34417 | CT of the Head | Palmetto GBA | 11/3/2017 | |
| L33457 | Cardiac Radionuclide Imaging | Palmetto GBA | 11/3/2017 | |
| L34556 | Spinal Cord Stimulators for Chronic Pain | Palmetto GBA | 11/3/2017 | |
| L34416 | Computerized Axial Tomography of the Chest/Thorax | Palmetto GBA | 11/3/2017 | |
| L34565 | Home Health-Surface Electrical Stimulation in the Treatment of Dysphagia | Palmetto GBA | 11/3/2017 | |
| L36209 | Cardiology – non-emergent outpatient testing: exercise stress test, stress echo, MPI SPECT, and cardiac PET | First Coast Service Options, Inc. | 11/3/2017 | |
| A55789 | Cardiology— non-emergent outpatient testing: exercise stress test, stress echo, MPI SPECT, and cardiac PET revision to the Part A and B LCD | First Coast Service Options, Inc. | 11/3/2017 | |
| A53001 | Wound Care | Novitas Solutions, Inc. | 11/3/2017 | |
| L35125 | Wound Care | Novitas Solutions, Inc. | 11/3/2017 | |
| L34938 | Removal of Benign Skin Lesions | Novitas Solutions, Inc. | 11/3/2017 | |
| L34999 | Transoral Incisionless Fundoplication | Novitas Solutions, Inc. | 11/3/2017 | |
| L36920 | Epidural Injections for Pain Management | Novitas Solutions, Inc. | 11/3/2017 | |
| L35093 | Intravenous Immune Globulin (IVIG) | Novitas Solutions, Inc. | 11/3/2017 | |
| L34093 | Chemotherapy and Biologicals | CGS Administrators, LLC | 11/3/2017 | |
| L35450 | Spinal Cord Stimulation (Dorsal Column Stimulation) | Novitas Solutions, Inc. | 11/3/2017 | |
| L35094 | Services That Are Not Reasonable and Necessary | Novitas Solutions, Inc. | 11/3/2017 | |
| A52986 | Biomarkers for Oncology | Novitas Solutions, Inc. | 11/3/2017 | |
| L35396 | Biomarkers for Oncology | Novitas Solutions, Inc. | 11/3/2017 | |
| A54862 | Nivolumab (Opdivo®) – Related to LCD L33394 | National Government Services, Inc. | 11/3/2017 | |
| A55791 | Corticotropin retired Part B LCD | First Coast Service Options, Inc. | 11/2/2017 | |
| A55790 | Creatine Kinase (CK), (CPK) retired Part A and Part B LCD | First Coast Service Options, Inc. | 11/2/2017 | |
| L36174 | MolDX: NSCLC, Comprehensive Genomic Profile Testing | CGS Administrators, LLC | 11/2/2017 | |
| L36113 | MolDX: MGMT Promoter Methylation Analysis | CGS Administrators, LLC | 11/2/2017 | |
| L36117 | MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease | CGS Administrators, LLC | 11/2/2017 | |
| A54240 | Bladder Tumor Marker FISH Billing and Coding Guidelines Update | CGS Administrators, LLC | 11/2/2017 | |
| A54242 | MolDX: 9p21 Genotype Test Coding and Billing Guideline | CGS Administrators, LLC | 11/2/2017 | |
| A54242 | MolDX: 9p21 Genotype Test Coding and Billing Guideline | CGS Administrators, LLC | 11/2/2017 | |
| A54272 | MolDX: KIF6 Genotype Billing and Coding Guidelines | CGS Administrators, LLC | 11/2/2017 | |
| A54260 | MolDX: CYP2B6 Test Coding and Billing Guidelines | CGS Administrators, LLC | 11/2/2017 | |
| A54269 | MolDX: HTTLPR Gene Testing Coding and Billing Guidelines | CGS Administrators, LLC | 11/2/2017 | |
| A54275 | MolDX: LPA-Aspirin Genotype Coding and Billing Guidelines | CGS Administrators, LLC | 11/2/2017 | |
| A54276 | MolDX: LPA-Intron 25 Genotype Coding and Billing Guidelines | CGS Administrators, LLC | 11/2/2017 | |
| A54186 | MolDX: AlloMap Billing and Coding Guidelines Update | CGS Administrators, LLC | 11/2/2017 | |
| A54241 | MolDX: 4q25-AF Risk Genotype Coding and Billing Guidelines | CGS Administrators, LLC | 11/2/2017 | |
| L36675 | MolDX- CDD: ProMark Risk Score | CGS Administrators, LLC | 11/2/2017 | |
| L36002 | MolDX-CDD: Prolaris™ Prostate Cancer Genomic Assay | CGS Administrators, LLC | 11/2/2017 | |
| L36206 | MolDX-CDD: Genomic Health™ Oncotype DX® Prostate Cancer Assay | CGS Administrators, LLC | 11/2/2017 | |
| A52885 (retired) | Non-coverage of Transoral Incisionless Fundoplication | Noridian Healthcare Solutions, LLC | 11/1/2017 | |
| A52893 (retired) | Non-coverage of Transoral Incisionless Fundoplication | Noridian Healthcare Solutions, LLC | 11/1/2017 | |
| L33617 | Erythropoiesis Stimulating Agents (ESA) | National Government Services, Inc. | 11/1/2017 | |
| A52380 (retired) | Hyperbaric Oxygen (HBO) Therapy – Medical Policy Article | National Government Services, Inc. | 10/31/2017 | |
| A54297 | MolDX: PTCH1 Gene Testing Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54296 | MolDX: PreDx® Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54295 | MolDX: PIK3CA Gene Tests Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54293 | MolDX: PAX6 Gene Sequencing Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54689 | MolDX: Myriad’s BRACAnalysis CDx™ Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54688 | MolDX: FDA-Approved KRAS Tests | CGS Administrators, LLC | 10/30/2017 | |
| A54598 | MolDX: FDA Approved ALK Companion Diagnostic Tests Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54687 | MolDX: CYP2C9 and/or VKORC1 Gene Testing for Warfarin Response Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54238 | MolDX: cobas® 4800 BRAF V600 Test Billing/Coding Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54685 | MolDX: Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C) Testing Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54686 | MolDX: BCR-ABL Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54201 | MolDX: Vectra™ DA Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54280 | MolDX: UGT1A1 Gene Analysis Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54281 | MolDX: TP53 Gene Test Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54200 | MolDX: therascreen® KRAS PCR Kit Billing/Coding Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54199 | MolDX: Therascreen® EGFR RGQ PCR Kit Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54282 | MolDX: TERC Gene Tests Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54283 | MolDX: SULT4A1 Genetic Testing Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54284 | MolDX: STAT3 Gene Testing Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54285 | MolDX: SMPD1 Genetic Testing Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54286 | MolDX: SLCO1B1 Genotype Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54300 | MolDx: SEPT9 Gene Test Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54299 | MolDX: RPS19 Gene Tests Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54198 | MolDX: ResponseDX Tissue of Origin® Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54197 | MolDX: Progensa® PCA3 Assay Coverage Update | CGS Administrators, LLC | 10/30/2017 | |
| A54196 | MolDX: Oncotype DX® Colon Cancer Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54195 | MolDX: Oncotype DX® Breast Cancer Assay Billing and Coding Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54292 | MolDX: OncoCee™ Billing and Coding Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54291 | MolDX: NSD1 Gene Tests Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54290 | MolDX: myPap™ Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54288 | MolDX: Mitochondrial Nuclear Gene Tests Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54278 | MolDX: MECP2 Genetic Testing Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54277 | MolDX: MCOLN1 Genetic Testing Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54194 | MolDX: MammaPrint Billing and Coding Guidelines Update | CGS Administrators, LLC | 10/30/2017 | |
| A54276 | MolDX: LPA-Intron 25 Genotype Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54275 | MolDX: LPA-Aspirin Genotype Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54274 | MolDX: L1CAM Gene Sequencing Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54273 | MolDX: know error® Billing and Coding Guidelines Update | CGS Administrators, LLC | 10/30/2017 | |
| A54272 | MolDX: KIF6 Genotype Billing and Coding Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54271 | MolDX: Immunohistochemistry (IHC) Indications for Breast Pathology | CGS Administrators, LLC | 10/30/2017 | |
| A54270 | MolDX: IKBKAP Genetic Testing Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54269 | MolDX: HTTLPR Gene Testing Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54268 | MolDX: HEXA Gene Analysis Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54193 | MolDX: HERmark® Assay by Monogram Update | CGS Administrators, LLC | 10/30/2017 | |
| A54267 | MolDX: HBB Gene Tests Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54266 | MolDX: HAX1 Gene Sequencing Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54265 | MolDX: GBA Genetic Testing Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54264 | MolDX: Fragile X Coding and Billing Guidelines Update | CGS Administrators, LLC | 10/30/2017 | |
| A54192 | MolDX: FDA-Approved EGFR Tests | CGS Administrators, LLC | 10/30/2017 | |
| A54191 | MolDX: FDA-Approved BRAF Tests | CGS Administrators, LLC | 10/30/2017 | |
| A54263 | MolDX: FANCC Genetic Testing Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54262 | MolDX: ENG and ACVRL1 Gene Tests Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54260 | MolDX: CYP2B6 Test Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54189 | MolDX: cobas® EGFR Mutation Test Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54258 | MolDX: CFTR Gene Analysis Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54257 | MolDX: BluePrint® Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54256 | MolDX: BLM Gene Analysis Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54188 | MolDX: bioTheranostics Cancer TYPE ID® Update | CGS Administrators, LLC | 10/30/2017 | |
| A54255 | MolDX: BCKDHB Gene Test Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54187 | MolDX: Avise PG Assay Billing/Coding Update | CGS Administrators, LLC | 10/30/2017 | |
| A54254 | MolDX: ATP7B Gene Tests Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54253 | MolDX: Aspartoacyclase 2 Deficiency(ASPA) Testing Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54244 | MolDX: ApoE Genotype Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| L34416 | Computerized Axial Tomography of the Chest/Thorax | Palmetto GBA | 10/30/2017 | |
| A54186 | MolDX: AlloMap Billing and Coding Guidelines Update | CGS Administrators, LLC | 10/30/2017 | |
| A54185 | MolDX: Afirma™ Assay by Veracyte Update | CGS Administrators, LLC | 10/30/2017 | |
| A54242 | MolDX: 9p21 Genotype Test Coding and Billing Guideline | CGS Administrators, LLC | 10/30/2017 | |
| L34556 | Spinal Cord Stimulators for Chronic Pain | Palmetto GBA | 10/30/2017 | |
| A54241 | MolDX: 4q25-AF Risk Genotype Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| L33445 | Removal of Benign and Malignant Skin Lesions | Palmetto GBA | 10/30/2017 | |
| A54243 | MolDX: CHD7 Gene Analysis Coding and Billing Guidelines | CGS Administrators, LLC | 10/30/2017 | |
| A54240 | Bladder Tumor Marker FISH Billing and Coding Guidelines Update | CGS Administrators, LLC | 10/30/2017 | |
| L36954 | Noncovered Services other than CPT® Category III Noncovered Services | Palmetto GBA | 10/30/2017 | |
| L34555 | Non-Covered Category III CPT Codes | Palmetto GBA | 10/30/2017 | |
| L34045 | Non-Invasive Vascular Studies | CGS Administrators, LLC | 10/30/2017 | |
| L36675 | MolDX- CDD: ProMark Risk Score | CGS Administrators, LLC | 10/30/2017 | |
| L35443 | MolDX: GeneSight ® Assay for Refractory Depression | CGS Administrators, LLC | 10/30/2017 | |
| L36656 | MolDX-CDD: Decipher® Prostate Cancer Classifier Assay | CGS Administrators, LLC | 10/30/2017 | |
| L36021 | Molecular Diagnostic Tests (MDT) | CGS Administrators, LLC | 10/30/2017 | |
| L35349 | MolDX: Genetic Testing for Lynch Syndrome | CGS Administrators, LLC | 10/30/2017 | |
| A52437 | Sentinel Lymph Node Biopsy – Medical Policy Article | CGS Administrators, LLC | 10/30/2017 | |
| A52435 | Osteopathic Manipulative Treatment | CGS Administrators, LLC | 10/30/2017 | |
| A52528 | Allergen Immunotherapy | CGS Administrators, LLC | 10/30/2017 | |
| A54812 | Antibacterial Drugs | Palmetto GBA | 10/30/2017 | |
| L33952 | Cardiac Event Detection | CGS Administrators, LLC | 10/30/2017 | |
| L33947 | Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA) | CGS Administrators, LLC | 10/30/2017 | |
| L33959 | Cardiac Catheterization and Coronary Angiography | CGS Administrators, LLC | 10/30/2017 | |
| L33946 | Capsule Opacification Following Cataract Surgery: Discission and YAG Laser Capsulotomy | CGS Administrators, LLC | 10/30/2017 | |
| L33944 | Blepharoplasty | CGS Administrators, LLC | 10/30/2017 | |
| L32553 | Allergy Immunotherapy | CGS Administrators, LLC | 10/30/2017 | |
| A55521 (retired) | Response to Comments: White Cell Colony Stimulating Factors | Palmetto GBA | 10/30/2017 | |
| A55517 (retired) | Response to Comments: CT of the Head | Palmetto GBA | 10/30/2017 |
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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