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Centers for Medicare & Medicaid Services (CMS) October 2017 Local Coverage Determination (LCD) Updates

Click here to the view the Centers for Medicare & Medicaid Services (CMS) October 2017 Local Coverage Determination (LCD) Updates »

October 2017 updates:

Document IDDocument TitleContractorLast Updated On
A52370 Bevacizumab (e.g., Avastin™) – Related to LCD L33394National Government Services, Inc.10/20/2017
L35490 Category III CodesWisconsin Physicians Service Insurance Corporation10/17/2017
L34093 Chemotherapy and BiologicalsCGS Administrators, LLC10/20/2017
A55769 Coenzyme Q10 (Q10) Coding and Billing GuidelineNoridian Healthcare Solutions, LLC10/19/2017
A55770 Coenzyme Q10 (Q10) Coding and Billing GuidelineNoridian Healthcare Solutions, LLC10/19/2017
A55423 (retired) DecisionDx-UM™ Billing GuidelinesNoridian Healthcare Solutions, LLC10/16/2017
A55424 (retired) DecisionDx-UM™Billing GuidelinesNoridian Healthcare Solutions, LLC10/16/2017
L33394 Drugs and Biologicals, Coverage of, for Label and Off-Label UsesNational Government Services, Inc.10/20/2017
L34741 Drugs and Biologics (Non-chemotherapy)Wisconsin Physicians Service Insurance Corporation10/17/2017
L35677 Infliximab (Remicade®)Palmetto GBA10/20/2017
A52423 Infliximab, Infliximab-dyyb, Infliximab-abda (e.g., Remicade™, Inflectra™, Renflexis) – Related to LCD L33394National Government Services, Inc.10/20/2017
L33434 (retired) K-ras Testing Required before Epidermal Growth Factor Receptor Antibody Use in Colorectal CancerPalmetto GBA10/17/2017
L33633 Magnetic Resonance Angiography (MRA)National Government Services, Inc.10/19/2017
L33795 Mechanical In-exsufflation DevicesCGS Administrators, LLC
Noridian Healthcare Solutions, LLC
10/19/2017
A53565 MolDX: CHD7 Gene Analysis Coding and Billing GuidelinesPalmetto GBA10/16/2017
A53652 MolDX: ApoE Genotype Coding and Billing GuidelinesPalmetto GBA10/17/2017
A53600 MolDX: BCKDHB Gene Test Coding and Billing GuidelinesPalmetto GBA10/17/2017
A53540 MolDX: BLM Gene Analysis Coding and Billing GuidelinesPalmetto GBA10/17/2017
A53484 MolDX: BluePrint® Coding and Billing GuidelinesPalmetto GBA10/17/2017
L36082 MolDX: BRCA1 and BRCA2 Genetic TestingPalmetto GBA10/20/2017
L36813 MolDX: BRCA1 and BRCA2 Genetic TestingWisconsin Physicians Service Insurance Corporation10/17/2017
A53615 MolDX: CFTR Gene Analysis Coding and Billing GuidelinesPalmetto GBA10/17/2017
L36044 MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative DiseasePalmetto GBA10/16/2017
L36795 MolDX: Molecular RBC PhenotypingWisconsin Physicians Service Insurance Corporation10/17/2017
A55197 MolDX: Next Generation Sequencing Coding and Billing GuidelinesWisconsin Physicians Service Insurance Corporation10/17/2017
A53702 MolDX: SEPT9 Gene Test Coding and Billing GuidelinesPalmetto GBA10/17/2017
A53698 MolDX: SLCO1B1 Genotype Coding and Billing GuidelinesPalmetto GBA10/16/2017
A53624 MolDX: SMPD1 Genetic Testing Coding and Billing GuidelinesPalmetto GBA10/16/2017
A53589 MolDX: TERC Gene Tests Coding and Billing GuidelinesPalmetto GBA10/17/2017
L36789 MolDX-CDD: Genomic Health™ Oncotype DX® Prostate Cancer AssayWisconsin Physicians Service Insurance Corporation10/17/2017
L36787 MolDX-CDD: Prolaris™ Prostate Cancer Genomic AssayWisconsin Physicians Service Insurance Corporation10/17/2017
L37011 MolDX-CDD: ProMark Risk ScoreWisconsin Physicians Service Insurance Corporation10/17/2017
L33370 NebulizersCGS Administrators, LLC
Noridian Healthcare Solutions, LLC
10/18/2017
A52466 Nebulizers – Policy ArticleCGS Administrators, LLC
Noridian Healthcare Solutions, LLC
10/18/2017
A54900 (retired) Next Generation Sequencing (NGS) and Tier 1 and Tier 2 Coding and Billing GuidelinesCGS Administrators, LLC10/18/2017
L36219 Non Covered ServicesNoridian Healthcare Solutions, LLC10/18/2017
L35008 Non-Covered ServicesNoridian Healthcare Solutions, LLC10/18/2017
L35761 Non-Invasive Peripheral Arterial Vascular StudiesWisconsin Physicians Service Insurance Corporation10/17/2017
L36582 Pathology and Laboratory: K-ras Testing prior to Treatment of Colorectal Cancer (CRC)Cahaba Government Benefit Administrators®, LLC10/17/2017
L34520 Psychological and Neuropsychological TestsFirst Coast Service Options, Inc.10/19/2017
A55771 Psychological and neuropsychological tests revision to the Part A and B LCDFirst Coast Service Options, Inc.10/19/2017
L34200 Removal of Benign Skin LesionsCGS Administrators, LLC10/16/2017
A55502 (retired) Response to Comments: Allergy Skin TestingPalmetto GBA10/16/2017
A55501 (retired) Response to Comments: Magnetic Resonance AngiographyPalmetto GBA10/16/2017
A55510 (retired) Response to Comments: Noncovered Services other than CPT® Category III Noncovered ServicesPalmetto GBA10/20/2017
A55504 (retired) Response to Comments: Octreotide Acetate for Injectable Suspension (Sandostatin LAR depot)Palmetto GBA10/16/2017
A55508 (retired) Response to Comments: Somatosensory TestingPalmetto GBA10/16/2017
A55506 (retired) Response to Comments: Transesophageal Echocardiography (TEE)Palmetto GBA10/16/2017
A52800 Self-Administered Drug Exclusion List (SAD List)Wisconsin Physicians Service Insurance Corporation10/17/2017
L36805 Special Histochemical Stains and Immunohistochemical StainsWisconsin Physicians Service Insurance Corporation10/17/2017
A53781 Spiracur SNaP® Wound Care SystemPalmetto GBA10/16/2017
L34297 Surgery: Removal of Benign or Premalignant Skin LesionsCahaba Government Benefit Administrators®, LLC10/17/2017
L34641 Transcranial Magnetic Stimulation (TMS)Wisconsin Physicians Service Insurance Corporation10/17/2017
L33579 Transesophageal Echocardiography (TEE)National Government Services, Inc.10/20/2017
L33577 Transthoracic Echocardiography (TTE)National Government Services, Inc.10/20/2017
L33577 Transthoracic Echocardiography (TTE)National Government Services, Inc.10/20/2017
L34587 Wound CareWisconsin Physicians Service Insurance Corporation10/17/2017
A52849 Breast Imaging: Breast Echography (Sonography)/Breast MRI/Ductography – Supplemental Instructions ArticleNational Government Services, Inc.10/12/2017
A52953 Chemotherapy AdministrationNoridian Healthcare Solutions, LLC10/12/2017
A52991 Chemotherapy AdministrationNoridian Healthcare Solutions, LLC10/12/2017
L37126 Coenzyme Q10 (CoQ10)CGS Administrators, LLC10/10/2017
DL37575 Frequency of HemodialysisCGS Administrators, LLC10/13/2017
L35132 Home Health Plans of Care: Monitoring Glucose Control in the Medicare Home Health Population with Type II Diabetes MellitusPalmetto GBA10/13/2017
A55754 Home PT/INR Monitoring (G0249) Billing and CodingNoridian Healthcare Solutions, LLC10/11/2017
A55756 Home PT/INR Monitoring (G0249) Billing and CodingNoridian Healthcare Solutions, LLC10/11/2017
L35878 Infectious Disease Molecular Diagnostic TestingCGS Administrators, LLC10/11/2017
L33704 Infliximab (Remicade TM )First Coast Service Options, Inc.10/12/2017
A55764 Infliximab (Remicade™) — revision to the Part A and B LCDFirst Coast Service Options, Inc.10/12/2017
A54767 Medicare Preventive Coverage for Certain VaccinesPalmetto GBA10/12/2017
DL37578 Micro-Invasive Glaucoma Surgery (MIGS)CGS Administrators, LLC10/13/2017
L37303 MolDX: AlloSure® Donor-Derived Cell-Free DNA TestNoridian Healthcare Solutions, LLC10/11/2017
L37358 MolDX: AlloSure® Donor-Derived Cell-Free DNA TestNoridian Healthcare Solutions, LLC10/11/2017
A54685 MolDX: Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C) Testing Coding and Billing GuidelinesCGS Administrators, LLC10/10/2017
A54253 MolDX: Aspartoacyclase 2 Deficiency(ASPA) Testing Coding and Billing GuidelinesCGS Administrators, LLC10/10/2017
A54253 MolDX: Aspartoacyclase 2 Deficiency(ASPA) Testing Coding and Billing GuidelinesCGS Administrators, LLC10/10/2017
A54254 MolDX: ATP7B Gene Tests Coding and Billing GuidelinesCGS Administrators, LLC10/10/2017
A54187 MolDX: Avise PG Assay Billing/Coding UpdateCGS Administrators, LLC10/11/2017
A55028 MolDX: Bladder Tumor Marker FISH Billing and Coding GuidelinesNoridian Healthcare Solutions, LLC10/11/2017
A55029 MolDX: Bladder Tumor Marker FISH Billing and Coding GuidelinesNoridian Healthcare Solutions, LLC10/11/2017
L36117 MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative DiseaseCGS Administrators, LLC10/11/2017
A54267 MolDX: HBB Gene Tests Coding and Billing GuidelinesCGS Administrators, LLC10/10/2017
A54268 MolDX: HEXA Gene Analysis Coding and Billing GuidelinesCGS Administrators, LLC10/10/2017
A54278 MolDX: MECP2 Genetic Testing Coding and Billing GuidelinesCGS Administrators, LLC10/10/2017
A54288 MolDX: Mitochondrial Nuclear Gene Tests Coding and Billing GuidelinesCGS Administrators, LLC10/10/2017
A54290 MolDX: myPap™ Coding and Billing GuidelinesCGS Administrators, LLC10/10/2017
A54689 MolDX: Myriad’s BRACAnalysis CDx™ Coding and Billing GuidelinesCGS Administrators, LLC10/10/2017
A54901 MolDX: Next Generation Sequencing Coding and Billing GuidelinesCGS Administrators, LLC10/11/2017
A54291 MolDX: NSD1 Gene Tests Coding and Billing GuidelinesCGS Administrators, LLC10/10/2017
A54292 MolDX: OncoCee™ Billing and Coding GuidelinesCGS Administrators, LLC10/10/2017
A54293 MolDX: PAX6 Gene Sequencing Coding and Billing GuidelinesCGS Administrators, LLC10/10/2017
L37142 MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk DiseaseCGS Administrators, LLC10/10/2017
L37134 MolDX: Xpresys LungCGS Administrators, LLC10/10/2017
A53446 Oral Surgery and Maxillofacial Surgery Specialty CodesPalmetto GBA10/10/2017
A53444 Periodic Adjustment of Gastric Restrictive Device after the Global Period: Coding and Billing InstructionsPalmetto GBA10/11/2017
A55760 Response to Comments: MolDX: AlloSure® Donor-Derived Cell-Free DNA TestNoridian Healthcare Solutions, LLC10/11/2017
A55761 Response to Comments: MolDX: AlloSure® Donor-Derived Cell-Free DNA TestNoridian Healthcare Solutions, LLC10/11/2017
A55762 Special Stains and Immunohistochemistry (IHC) Indications for Gastric PathologyCGS Administrators, LLC10/11/2017
L33312 Wheelchair SeatingCGS Administrators, LLC
Noridian Healthcare Solutions, LLC
10/11/2017
L37166 Wound CareFirst Coast Service Options, Inc.10/13/2017
A55767 Wound care – New Part A and Part B LCDFirst Coast Service Options, Inc.10/13/2017
A55757 Wound care (L37166): Medicare Part A/B local coverage determination (LCD) comment summaryFirst Coast Service Options, Inc.10/13/2017
A55757 Wound care (L37166): Medicare Part A/B local coverage determination (LCD) comment summaryFirst Coast Service Options, Inc.10/13/2017
A54735 Billing Requirements for PET Scan Claims to Identify Bone Metastasis of CancerPalmetto GBA10/09/2017
L33557 Cardiac Catheterization and Coronary AngiographyNational Government Services, Inc.10/04/2017
A55758 Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Physician RequirementsNovitas Solutions, Inc.10/06/2017
L34093 Chemotherapy and BiologicalsCGS Administrators, LLC10/09/2017
L34415 CT of the Abdomen and PelvisPalmetto GBA10/06/2017
L37078 Genomic Sequence Analysis Panels in the Treatment of Myelodysplastic Syndromes (MDS)National Government Services, Inc.10/05/2017
L37244 Micro-Invasive Glaucoma Surgery (MIGS)National Government Services, Inc.10/05/2017
A53419 Neuromodulation for Fecal IncontinencePalmetto GBA10/09/2017
A54862 Nivolumab (Opdivo®) – Related to LCD L33394National Government Services, Inc.10/06/2017
A52479 Oral Anticancer Drugs – Policy ArticleCGS Administrators, LLC

Noridian Healthcare Solutions, LLC

10/06/2017
A53472 Pre/Postoperative Care: Date of ServicePalmetto GBA10/09/2017
L34282 Radiology: Proton Beam TherapyCahaba Government Benefit Administrators®, LLC10/09/2017
A55701 Response to Comments: Genomic Sequence Analysis Panels in the Treatment of Myelodysplastic SyndromesNational Government Services, Inc.10/05/2017
A55707 Response to Comments: Micro-Invasive Glaucoma Surgery (MIGS)National Government Services, Inc.10/05/2017
A55749 Response to Comments: Select Minimally Invasive GERD ProceduresNational Government Services, Inc.10/06/2017
L34061 Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)CGS Administrators, LLC10/03/2017
L35080 Select Minimally Invasive GERD ProceduresNational Government Services, Inc.10/06/2017
A52527 Self-Administered Drug Exclusion List and Biologicals Excluded from Coverage – Medical Policy Article (R7)CGS Administrators, LLC10/02/2017
L34298 Surgery: Transoral Incisionless Fundoplication (TIF)Cahaba Government Benefit Administrators®, LLC10/03/2017
L34087 Surveillance of Implantable or Wearable Cardioverter Defibrillators (ICDs): Office, Hospital, Web, or Non-Web BasedCGS Administrators, LLC10/04/2017
A53784 The Routine Costs of Investigational Chemotherapy Drugs Studied In a Qualifying Clinical TrialPalmetto GBA10/09/2017
L33579 Transesophageal Echocardiography (TEE)National Government Services, Inc.10/03/2017
L33577 Transthoracic Echocardiography (TTE)National Government Services, Inc.10/04/2017
A52416 Vertebroplasty and Vertebral Augmentation (Percutaneous) – Supplemental Instructions ArticleCGS Administrators, LLC10/02/2017
A52417 Visual Fields Testing – Supplemental Instructions ArticleCGS Administrators, LLC10/02/2017
A55741 2018 ICD-10-CM Coding Changes (Part A/B, Part A and Part B)First Coast Service Options, Inc.09/27/2017
A55607 Additional Information Required for Coverage and Pricing for Category III CPT® CodesNoridian Healthcare Solutions, LLC09/28/2017
A55681 Additional Information Required for Coverage and Pricing for Category III CPT® CodesNoridian Healthcare Solutions, LLC09/28/2017
A54574 Ambulance Services (Ground Ambulance)Novitas Solutions, Inc.09/29/2017
L34914 Assays for Vitamins and Metabolic FunctionNovitas Solutions, Inc.09/29/2017
L35395 Autonomic Function TestsNovitas Solutions, Inc.09/29/2017
L35022 Bariatric Surgical Management of Morbid ObesityNovitas Solutions, Inc.09/29/2017
L35433 Barium Swallow Studies, ModifiedNovitas Solutions, Inc.09/29/2017
L35396 Biomarkers for OncologyNovitas Solutions, Inc.09/29/2017
L35062 Biomarkers OverviewNovitas Solutions, Inc.09/29/2017
L34833 Cardiac Rhythm Device EvaluationNovitas Solutions, Inc.09/29/2017
L35083 Cardiovascular Nuclear MedicineNovitas Solutions, Inc.09/29/2017
A52953 Chemotherapy AdministrationNoridian Healthcare Solutions, LLC09/28/2017
A52991 Chemotherapy AdministrationNoridian Healthcare Solutions, LLC09/28/2017
L34093 Chemotherapy and BiologicalsCGS Administrators, LLC09/25/2017
L35424 Chiropractic ServicesNovitas Solutions, Inc.09/29/2017
L35006 Controlled Substance Monitoring and Drugs of Abuse TestingNovitas Solutions, Inc.09/29/2017
L36920 Epidural Injections for Pain ManagementNovitas Solutions, Inc.09/29/2017
L34974 Facet Joint InjectionsNovitas Solutions, Inc.09/29/2017
L35032 Flow CytometryNovitas Solutions, Inc.09/29/2017
L35014 Frequency of DialysisNovitas Solutions, Inc.09/29/2017
L35099 Frequency of Laboratory TestsNovitas Solutions, Inc.09/29/2017
L33431 HbA1cPalmetto GBA09/29/2017
A53827 (retired) HemoDialysis FrequencyNoridian Healthcare Solutions, LLC10/01/2017
A53829 (retired) HemoDialysis FrequencyNoridian Healthcare Solutions, LLC10/01/2017
L35021 Hyperbaric Oxygen (HBO) TherapyNovitas Solutions, Inc.09/29/2017
L36711 Intensity Modulated Radiation Therapy (IMRT)Novitas Solutions, Inc.09/29/2017
L35003 Intraoperative Neurophysiological TestingNovitas Solutions, Inc.09/29/2017
L35093 Intravenous Immune Globulin (IVIG)Novitas Solutions, Inc.09/29/2017
L34865 Magnetic Resonance Angiography (MRA)Novitas Solutions, Inc.09/29/2017
A55595 MolDX: BCR-ABL Billing and Coding GuidelinesNoridian Healthcare Solutions, LLC09/28/2017
A55600 MolDX: BCR-ABL Coding and Billing GuidelinesNoridian Healthcare Solutions, LLC09/28/2017
L36044 MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative DiseasePalmetto GBA09/27/2017
L36180 MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative DiseaseNoridian Healthcare Solutions, LLC09/29/2017
L36186 MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative DiseaseNoridian Healthcare Solutions, LLC09/29/2017
A55274 MolDX: Know error® Billing and Coding Guidelines UpdateNoridian Healthcare Solutions, LLC09/29/2017
A55275 MolDX: Know error® Billing and Coding Guidelines UpdateNoridian Healthcare Solutions, LLC09/29/2017
A55285 MolDX: MECP2 Genetic Testing Billing and Coding GuidelinesNoridian Healthcare Solutions, LLC09/28/2017
A55286 MolDX: MECP2 Genetic Testing Billing and Coding GuidelinesNoridian Healthcare Solutions, LLC09/28/2017
L35974 MolDX: MGMT Promoter Methylation AnalysisPalmetto GBA09/27/2017
A55290 MolDX: Mitochondrial Nuclear Gene Tests Billing and Coding GuidelinesNoridian Healthcare Solutions, LLC09/29/2017
A55291 MolDX: Mitochondrial Nuclear Gene Tests Billing and Coding GuidelinesNoridian Healthcare Solutions, LLC09/29/2017
A55292 MolDX: myPap™ Billing and Coding GuidelinesNoridian Healthcare Solutions, LLC09/29/2017
A55293 MolDX: myPap™ Billing and Coding GuidelinesNoridian Healthcare Solutions, LLC09/29/2017
L36143 MolDX: NSCLC, Comprehensive Genomic Profile TestingPalmetto GBA09/27/2017
A55593 MolDX: OncoCee™ Billing and Coding GuidelinesNoridian Healthcare Solutions, LLC09/29/2017
A55598 MolDX: OncoCee™ Billing and Coding GuidelinesNoridian Healthcare Solutions, LLC09/29/2017
A55594 MolDX: PreDx® Billing and Coding GuidelinesNoridian Healthcare Solutions, LLC09/29/2017
A55599 MolDX: PreDx® Billing and Coding GuidelinesNoridian Healthcare Solutions, LLC09/29/2017
L35049 Monitored Anesthesia CareNovitas Solutions, Inc.09/29/2017
A53134 NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic ConditionsNovitas Solutions, Inc.09/29/2017
A53132 NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Oncologic ConditionsNovitas Solutions, Inc.09/29/2017
L35081 Nerve Conduction Studies and ElectromyographyNovitas Solutions, Inc.09/29/2017
L34996 Neuromuscular Junction TestingNovitas Solutions, Inc.09/29/2017
L34975 Neurophysiology Evoked Potentials (NEPs)Novitas Solutions, Inc.09/29/2017
L35397 Non-Invasive Cerebrovascular Arterial StudiesNovitas Solutions, Inc.09/29/2017
L35451 Non-Invasive Peripheral Venous StudiesNovitas Solutions, Inc.09/29/2017
L35409 Non-Vascular Extremity UltrasoundNovitas Solutions, Inc.09/29/2017
A52769 (retired) Ocular Photodynamic Therapy (OPT) with VerteporfinNoridian Healthcare Solutions, LLC10/01/2017
A54129 (retired) Ocular Photodynamic Therapy (OPT) with VerteporfinNoridian Healthcare Solutions, LLC10/01/2017
L35434 Oximetry ServicesNovitas Solutions, Inc.09/29/2017
L35107 Pain Management of Peripheral Nerves by InjectionNovitas Solutions, Inc.09/29/2017
L35101 Psychiatric CodesNovitas Solutions, Inc.09/29/2017
L35360 Pulmonary Function TestingNovitas Solutions, Inc.09/29/2017
L34276 Radiology: Computed Tomographic Angiography of the Heart and Coronary VesselsCahaba Government Benefit Administrators®, LLC09/26/2017
L35138 Routine Foot CareNovitas Solutions, Inc.09/29/2017
L35038 Scanning Computerized Ophthalmic Diagnostic ImagingNovitas Solutions, Inc.09/29/2017
L35070 Speech – Language Pathology (SLP) Services: Communication DisordersNovitas Solutions, Inc.09/29/2017
L36423 StrappingNovitas Solutions, Inc.09/29/2017
L35035 Thoracic Aortography and Carotid, Vertebral, and Subclavian AngiographyNovitas Solutions, Inc.09/29/2017
L35428 Thrombolytic AgentsNovitas Solutions, Inc.09/29/2017
L35016 Transesophageal Echocardiography (TEE)Novitas Solutions, Inc.09/29/2017
L34924 Treatment of Varicose Veins and Venous Stasis Disease of the Lower ExtremitiesNovitas Solutions, Inc.09/29/2017
L35350 Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)Novitas Solutions, Inc.09/29/2017
L33576 UrodynamicsNational Government Services, Inc.09/29/2017
A52445 (retired) Verteporfin (e.g., Visudyne™) – Related to LCD L33394National Government Services, Inc.09/30/2017
A55757 Wound care (L37166): Medicare Part A/B local coverage determination (LCD) comment summaryFirst Coast Service Options, Inc.09/28/2017
A54559 Xofigo Billing InstructionsPalmetto GBA09/25/2017
A52455 (retired) Zoledronic Acid (e.g., Zometa ®, Reclast® ) – Related to LCD L33394National Government Services, Inc.09/30/2017

 

 

Click here to the view the Centers for Medicare & Medicaid Services (CMS) October 2017 Local Coverage Determination (LCD) Updates »

 

 

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