Medicare (CMS) Local Coverage Determination (LCD) Updates – June 2019

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

June 2019 Medicare (CMS) LCD Updates:

• A56609             Billing and Coding: Biomarker Testing (Prior to Initial Biopsy) for Prostate Cancer Diagnosis
• A56606             Billing and Coding: Cardiac Event Detection
• A56606             Billing and Coding: Cardiac Event Detection
• A56613             Billing and Coding: Cataract Surgery
• A56607             Billing and Coding: Continuous Peripheral Nerve Blocks (CPNB)
• A56607             Billing and Coding: Continuous Peripheral Nerve Blocks (CPNB)
• A56611             Billing and Coding: Corneal Pachymetry
• A56611             Billing and Coding: Corneal Pachymetry
• A56612             Billing and Coding: CT of the Head
• A56612             Billing and Coding: CT of the Head
• A56610             Billing and Coding: Hospice Cardiopulmonary Conditions
• A56610             Billing and Coding: Hospice Cardiopulmonary Conditions
• A56588             Billing and Coding: Micro-Invasive Glaucoma Surgery (MIGS)
• A56178             Billing and Coding: Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF)
• A55336             Billing and Coding: Retroperitoneal Ultrasound
• A56590             Billing and Coding: Water Vapor Thermal Therapy for LUTS/BPH
• DL37733           Biomarker Testing (Prior to Initial Biopsy) for Prostate Cancer Diagnosis
• L34573              Cardiac Event Detection
• L37126              Coenzyme Q10 (CoQ10)
• L37641              Continuous Peripheral Nerve Blocks (CPNB)
• L33630              Corneal Pachymetry
• L34512              Corneal Pachymetry
• L34417              CT of the Head
• L34548              Hospice Cardiopulmonary Conditions
• A54953             Independent Diagnostic Testing Facilities- physician supervision and technician requirements
• DL37244           Micro-Invasive Glaucoma Surgery (MIGS)
• L37134              MolDX: BDX-XL2
• L37818              MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Very Low and Low Risk Disease
• L37820              MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Very Low and Low Risk Disease
• L37130              MolDX: DecisionDx-UM (Uveal Melanoma)
• L37130              MolDX: DecisionDx-UM (Uveal Melanoma)
• L36206              MolDX: Genomic Health™ Oncotype DX® Prostate Cancer Assay
• L36206              MolDX: Genomic Health™ Oncotype DX® Prostate Cancer Assay
• L36048              MolDX: HLA-B*15:02 Genetic Testing
• L36145              MolDX: HLA-B*15:02 Genetic Testing
• L36149              MolDX: HLA-B*15:02 Genetic Testing
• A54445             MolDX: MammaPrint Billing and Coding Guidelines
• A54447             MolDX: MammaPrint Billing and Coding Guidelines
• L36113              MolDX: MGMT Promoter Methylation Analysis
• L37142              MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease
• L34171              Nasal Punctum-Nasolacrimal Duct Dilation and Probing with or without Irrigation
• L34175              Ophthalmic Angiography (Fluorescein and Indocyanine Green)
• L34181              Ophthalmic Biometry for Intraocular Lens Power Calculation
• L34399              Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
• L34049              Outpatient Physical and Occupational Therapy Services
• A52400             Outpatient Physical and Occupational Therapy Services Supplemental Instructions Article
• L34353              Outpatient Psychiatry and Psychology Services
• A52403             Outpatient Psychiatry and Psychology Services – Supplemental Instructions Article
• DL33569           Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF)
• A52535             Process for Determining Self-Administered Drug Exclusions – Medical Policy Article
• DL37808           Water Vapor Thermal Therapy for LUTS/BPH
• L36690              Wound Application of Cellular and/or Tissue Based Products (CTPs), Lower Extremities
• A53387             Aflibercept (EYLEA®) Coding and Billing Guidelines
• A56627             Billing and Coding Beleodaq (Belinostat)
• A56628             Billing and Coding Fluocinolone Acetonide Intravitreal Implant
• A56629             Billing and Coding Iron Sucrose, Iron Dextran and Ferumoxytol, (Intravenous Iron Therapy)
• A56630             Billing and Coding Sodium Ferric Gluconate, (Intravenous Iron Therapy)
• A52986             Billing and Coding: Biomarkers for Oncology
• A56591             Billing and Coding: Blood Glucose Monitoring in a Skilled Nursing Facility (SNF)
• A56600             Billing and Coding: Cardiac Event Detection Monitoring
• A56602             Billing and Coding: Cardiac Rhythm Device Evaluation
• A56615             Billing and Coding: Cataract Extraction (including Complex Cataract Surgery)
• A56613             Billing and Coding: Cataract Surgery
• A56616             Billing and Coding: Chiropractic Services
• A56616             Billing and Coding: Chiropractic Services
• A56248             Billing and Coding: Corneal Hysteresis
• A56608             Billing and Coding: Corus^® CAD Test
• A56625             Billing and Coding: Echocardiography
• A56625             Billing and Coding: Echocardiography
• A56619             Billing and Coding: Nerve Conduction Studies and Electromyography
• A56619             Billing and Coding: Nerve Conduction Studies and Electromyography
• A56614             Billing and Coding: Pyschiatric Inpatient Hospitalization
• L35396              Biomarkers for Oncology
• L34834              Blood Glucose Monitoring in a Skilled Nursing Facility (SNF)
• L34953              Cardiac Event Detection Monitoring
• L34833              Cardiac Rhythm Device Evaluation
• L35091              Cataract Extraction (including Complex Cataract Surgery)
• L34413              Cataract Surgery
• L34093              Chemotherapy and Biologicals
• L37387              Chiropractic Services
• L38014              Corneal Hysteresis
• L36713              Corus^® CAD Test
• L37379              Echocardiography
• A54689             MolDX: Myriad’s BRACAnalysis CDx™ Coding and Billing Guidelines
• A55597             MolDX: PIK3CA Gene Tests Billing and Coding Guidelines
• A55602             MolDX: PIK3CA Gene Tests Billing and Coding Guidelines
• A53558             MolDX: PIK3CA Gene Tests Coding and Billing Guidelines
• A54295             MolDX: PIK3CA Gene Tests Coding and Billing Guidelines
• L35048              Nerve Conduction Studies and Electromyography
• A52479             Oral Anticancer Drugs – Policy Article
• L34570              Psychiatric Inpatient Hospitalization
• A56529             Response to Comments: Corneal Hysteresis
• L34577              Retroperitoneal Ultrasound
• A53066             Self-Administered Drug Exclusion List:
• A52505             Wheelchair Seating – Policy Article
• A56632             Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy
• A56632             Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy
• A56639             Billing and Coding: Hospice Alzheimer’s Disease & Related Disorders
• A56639             Billing and Coding: Hospice Alzheimer’s Disease & Related Disorders
• A56621             Billing and Coding: Swallowing Studies for Dysphagia
• A56621             Billing and Coding: Swallowing Studies for Dysphagia
• L35091              Cataract Extraction (including Complex Cataract Surgery)
• L37126              Coenzyme Q10 (CoQ10)
• L34454              Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy
• L34741 (retired) Drugs and Biologics (Non-chemotherapy)
• A52531 (retired)        Fluocinolone acetonide intravitreal implant
• L35132              Home Health Plans of Care: Monitoring Glucose Control in the Medicare Home Health Population with Type II Diabetes Mellitus
• L34566              Hospice – HIV Disease
• L34567              Hospice Alzheimer’s Disease & Related Disorders
• L34558              Hospice The Adult Failure To Thrive Syndrome
• A52427 (retired)        Iron Sucrose, Iron Dextran and Ferumoxytol, (Intravenous Iron Therapy)
• A53101             MolDX: bioTheranostics Cancer TYPE ID® Update
• L36117              MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease
• L36011              MolDX: Molecular RBC Phenotyping
• L34045              Non-Invasive Vascular Studies
• A56212 (retired)        Response to Comments: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy
• A52429 (retired)        Sodium Ferric Gluconate, (Intravenous Iron Therapy)
• L35986              Special Histochemical Stains and Immunohistochemical Stains
• L33449              Swallowing Studies for Dysphagia

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

Policy Alerts monitors Commercial and Medicare medical policies for changes. While medical Insurance carriers typically update medical policies annually, there are many reasons why they might review or update a policy. When reviews occur out of cycle they often go unnoticed. Policy Alerts keeps you updated when Payers make coverage changes to medical policies affecting your business.

Policy Alerts continuously monitors Commercial and Medicare Payer coverage information to keep you up-to-date on medical Insurance decisions in real-time. When changes occur, instant email alerts are delivered to your inbox. Clients have access to detailed coverage reports and medical policies through the interactive Policy Alerts Dashboard portal. Save time each month and keep focused on important Payer medical policy reviews and coverage decisions affecting your business!

Policy Alerts takes a client-focused hands-on approach and is constantly working to provide our customers with helpful insights and actionable analytics. We understand what our clients need and are dedicated to providing timely, accurate, and always up-to-date reports.

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. All product and company names are trademarks™ or registered® trademarks of their respective holders. Use of them does not imply any affiliation with or endorsement by them. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice.