Medicare Administrative Contractor (MAC) First Coast Service Options (FCSO) has posted on its Web site local coverage determination (LCD) revisions, most of which are effective for claims processed on or after July 6, for services rendered on or after July 1. Providers and staff serving Medicare patients in Florida, Puerto Rico, and the U.S. Virgin Islands (jurisdiction 9) should familiarize themselves with these changes.
Skin Substitute LCD (L28985 and L29279)
Codes added to the noncovered products section of this LCD include HCPCS Level II codes C9363, J3590, and Q4115.
C9363 - Skin substitute, Integra Meshed Bilayer Wound Matrix, per square centimeter (ASC only)
J3590 – Skin substitute, Integra Meshed Bilayer Wound Matrix, per square centimeter (Provider only)
Q4115 - Skin substitute, alloskin, per square centimeter
FCSO has also revised its list of noncovered Medicare services (LCD L29288 and L29398) to incude the following newly-added CPT® codes:
Local Noncoverage Decisions – Devices
CPT® code 0199T Physiologic recording of tremor using accelerometer(s) and gyroscope(s), (including frequency and amplitude) including interpretation and report
Local Noncoverage Decisions – Drugs and Biologicals
CPT® code 90670 Pneumococcal conjugate vaccine, 13 valent, for intramuscular use
Local Noncoverage Decisions – Procedures
CPT® code 0202T Posterior vertebral joint(s) arthroplasty (e.g. facet joint[s] replacement) including facetectomy, laminectomy, foraminotomy and vertebral column fixation, with or without injection of bone cement, including fluoroscopy, single level, lumbar spine
Local Coverage Decision
The non-surgical Renessa® treatment, represented by CPT® code 0193T Transurethral, radiofrequency micro-remodeling of the female bladder neck and proximal urethra for stress urinary incontinence and ICD-9-CM code 625.6 Stress urinary incontinence, female, is indicated for the transurethral treatment of female stress urinary incontinence (SUI) due to hypermobility in women who have failed conservative treatment and who are not candidates for surgical therapy.
FCSO has removed 0193T from its list of noncovered Medicare services and will consider reimbursement of this code on a case-by-case basis only.
To ensure payment, physicians submitting claims for Renessa® should follow federally approved guidelines and stay in accordance with the indications supported by peer-reviewed literature, which limits its use to moderate to severe SUI in women.
Providers submitting claims to FCSO should no longer use CPT® code 53899 Unlisted procedure, urinary system to report Renessa® treatments with dates of service on or after July 1.
LCDs are available through the CMS Medicare Coverage Database. Coding Guidelines for an LCD (when present) may be found by selecting “LCD Attachments” in the “Jump to Section,” drop-down menu at the top of the LCD page.