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

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

March 2019 Medicare (CMS) LCD Updates:

• L34549                Ambulance Services
• A52422               Billing and Codeing for Autologous Cellular Immunotherapy Treatment of Metastatic Prostate Cancer
• A52422               Billing and Codeing for Autologous Cellular Immunotherapy Treatment of Metastatic Prostate Cancer
• A52530               Billing and Coding for Capsaicin 8% patch (Qutenza®)
• A52530               Billing and Coding for Capsaicin 8% patch (Qutenza®)
• A56534               Billing and Coding for Denosumab (Prolia™, Xgeva™)
• A56543               Billing and Coding for Durvalumab (Imfinzi)
• A56514               Billing and Coding for Pathology Services on the Same Date of Service (DOS) as Mohs Surgery
• A56515               Billing and Coding for Pathology Services on the Same Date of Service (DOS) as Mohs Surgery
• A56468               Billing and Coding: Ambulance Services
• A56476               Billing and Coding: Cardiac Radionuclide Imaging
• A56545               Billing and Coding: Hospice – Renal Care
• A56545               Billing and Coding: Hospice – Renal Care
• A56506               Billing and Coding: Noncovered Services other than CPT® Category III Noncovered Services
• A56531               Billing and Coding: Octreotide Acetate for Injectable Suspension (Sandostatin LAR® depot)
• A56531               Billing and Coding: Octreotide Acetate for Injectable Suspension (Sandostatin LAR® depot)
• A56389               Billing and Coding: Upper Gastrointestinal Endoscopy and Visualization
• L33457                Cardiac Radionuclide Imaging
• L34093                Chemotherapy and Biologicals
• A52424 (retired)  Denosumab (Prolia ™, Xgeva ™)
• L34559                Hospice – Renal Care
• L34422                Infrared Coagulation (IRC) of Hemorrhoids
• A53101               MolDX: bioTheranostics Cancer TYPE ID® Update
• L37785                MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Very Low and Low Risk Disease
• L35868                MolDX: Decipher® Prostate Cancer Classifier Assay
• L33438                Octreotide Acetate for Injectable Suspension (Sandostatin LAR® depot)
• A56172 (retired)  Response to Comments: Micro-Invasive Glaucoma Surgery (MIGS)
• A56150 (retired)  Response to Comments: MolDX: Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification (NAATs)
• A56174 (retired)  Response to Comments: MolDX: Oncotype DX AR-V7 Nucleus Detect for Men with Metastatic Castrate Resistant Prostate Cancer (MCRPC)
• L35080                Select Minimally Invasive GERD Procedures
• L34578                Surface Electrical Stimulation in the Treatment of Dysphagia
• DL34823             Tumor Treatment Field Therapy (TTFT)
• L34434                Upper Gastrointestinal Endoscopy and Visualization
• L35408        3D Interpretation and Reporting of Imaging Studies
• L36240        Allergen Immunotherapy
• L33417        Allergy Skin Testing
• L36241        Allergy Testing
• L34977        Anorectal Manometry, Anal Electromyography, and Biofeedback Training for Perineal Muscles and Anorectal or Urethral Sphincters
• A56577       Billing and Coding for Docetaxel; Taxotere
• A56577       Billing and Coding for Docetaxel; Taxotere
• A56578       Billing and Coding for Infliximab; Remicade
• A56578       Billing and Coding for Infliximab; Remicade
• A56579       Billing and Coding for Paclitaxel; Taxol
• A56579       Billing and Coding for Paclitaxel; Taxol
• A56526       Billing and Coding: 3D Interpretation and Reporting of Imaging Studies
• A56538       Billing and Coding: Allergen Immunotherapy
• A56559       Billing and Coding: Allergy Skin Testing
• A56559       Billing and Coding: Allergy Skin Testing
• A56558       Billing and Coding: Allergy Testing
• A56530       Billing and Coding: Anorectal Manometry, Anal Electromyography, and Biofeedback Training for Perineal Muscles and Anorectal or Urethral Sphincters
• A56580       Billing and Coding: Computerized Axial Tomography (CT), Thorax
• A56580       Billing and Coding: Computerized Axial Tomography (CT), Thorax
• A56562       Billing and Coding: Health and Behavior Assessment/Intervention
• A56562       Billing and Coding: Health and Behavior Assessment/Intervention
• A56365       Billing and Coding: Non-Coronary Vascular Stents
• A56434 (retired)            Billing and Coding: Remote Perimetric or Microperimetric Patient Monitoring Systems
• A56497       Billing and Coding: Vestibular Function Testing
• A56419       Billing and Coding: Voretigene Neparvovec-rzyl (Luxturna™)
• L34093        Chemotherapy and Biologicals
• L34093        Chemotherapy and Biologicals
• L34093        Chemotherapy and Biologicals
• L33459        Computerized Axial Tomography (CT), Thorax
• L36029        Controlled Substance Monitoring and Drugs of Abuse Testing
• L37638        Health and Behavior Assessment/Intervention
• L34559        Hospice – Renal Care
• DL38139     Lab: Drug Interaction Testing
• DL38155     Lab: Drug Interaction Testing
• L35702        Mohs Micrographic Surgery
• L35704        Mohs Micrographic Surgery
• A54185       MolDX: Afirma™ Assay by Veracyte Update
• A54188       MolDX: bioTheranostics Cancer TYPE ID® Update
• DL38143     MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Favorable Intermediate Risk Disease
• DL38145     MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Favorable Intermediate Risk Disease
• DL38147     MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Unfavorable Intermediate Risk Disease
• DL38149     MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Unfavorable Intermediate Risk Disease
• L37130        MolDX: DecisionDx-UM (Uveal Melanoma)
• L37295        MolDX: EndoPredict® Breast Cancer Gene Expression Test
• L37311        MolDX: EndoPredict® Breast Cancer Gene Expression Test
• DL38127     MolDX: Guardant360® Plasma-Based Comprehensive Genomic Profiling in Solid Tumors
• DL38129     MolDX: Guardant360® Plasma-Based Comprehensive Genomic Profiling in Solid Tumors
• A54194       MolDX: MammaPrint Billing and Coding Guidelines Update
• DL38119     MolDX: Next-Generation Sequencing for Solid Tumors
• DL38121     MolDX: Next-Generation Sequencing for Solid Tumors
• DL38123     MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies
• DL38125     MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies
• DL38151     MolDX: Pigmented Lesion Assay
• DL38153     MolDX: Pigmented Lesion Assay
• DL38131     MolDX: Prospera
• DL38133     MolDX: Prospera
• A54901       MolDX: Targeted and Comprehensive Genomic Profile Next Generation Sequencing Testing in Cancer
• A54281       MolDX: TP53 Gene Test Coding and Billing Guidelines
• DL38135     MolDX: TruGraf Blood Gene Expression Test
• DL38137     MolDX: TruGraf Blood Gene Expression Test
• L35084        Non-Coronary Vascular Stents
• A52395       Ophthalmic Angiography (Fluorescein and Indocyanine Green) – Supplemental Instructions
• L34181        Ophthalmic Biometry for Intraocular Lens Power Calculation
• A52397       Ophthalmic Biometry for Intraocular Lens Power Calculation – Supplemental Instructions Article
• A52398       Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography) – Supplemental Instructions Article
• L37814 (retired) Remote Perimetric or Microperimetric Patient Monitoring Systems
• A56408 (retired)            Response to Comments: Remote Perimetric or Microperimetric Patient Monitoring Systems
• A53066       Self-Administered Drug Exclusion List:
• L34537        Vestibular Function Testing

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

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