Posts Tagged ‘LCD’

Health care providers in Colorado, New Mexico, Oklahoma and Texas submitting claims to TrailBlazer Health Enterprises should be aware of revisions the jurisdiction 4 (J4) Part A and Part B Medicare Administrative Contractor (A/B MAC) made, Oct. 5, to two local coverage determinations (LCD).

The revisions were made in response to a recent addition to the list of HCPCS Level II codes payable by Medicare, as noted in the October 2009 quarterly update released Aug. 28 by the Centers for Medicare & Medicaid Services (CMS). Read more »

Your practice may now be able to get paid for magnetic resonance imaging (MRI) when used for blood flow measurement. The Centers for Medicare & Medicaid Services (CMS) posted, Sept. 28, a decision memo stating that “the blanket noncoverage of MRI for blood flow determination at 220.2 is no longer supported by the available evidence.”

CMS says it will remove the phrase “blood flow measurement,” from the Nationally Noncovered Indications at 220.2(C)(2) of the National Coverage Determinations (NCD) Manual.

Coverage will be considered at the local level. Check with your local Medicare contractor for updated policy provisions.

For more details, go online to the CMS What’s New Report Results page and click on CAG-00399R.

The Centers for Medicare & Medicaid Services (CMS) issued, Sept. 25, new guidance that delegates Medicare contractors the authority to make an exception to clinical criteria described in a local coverage determination (LCD) on a case-by-case basis and even reconsider an LCD if evidence upholds necessity. Read more »

Florida, Puerto Rico, and U.S. Virgin Islands providers submitting claims to Part B Medicare Administrative Contractor (MAC) First Coast Service Options (FCSO) should become familiar with a number of Local Coverage Determinations (LCDs) in the works. Read more »

Noridian Administrative Services LLC (NAS) will be conducting two educational workshops geared toward durable medical equipment (DME) suppliers. Read more »

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.

Medicare Administrative Contractor (MAC) TrailBlazer recently announced an inadvertent coding error. ICD-9-CM diagnosis code 238.79 Other lymphatic and hematopoietic tissues, used to indicate B-cell lymphoproliferative disorders expressing the CD-20 antigen as a covered diagnosis for J9310 Injection, rituximab, 100 mg, should be replaced with ICD-9-CM diagnosis code 238.77 Post-Transplant Lymphoproliferative Disorder (PTLD).

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Noridian Administrative Services has clarified its coverage policy for chemotherapeutic drugs that may cause chemotherapy-induced anemia.

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Noridian Administrative Services, LLC (NAS) announced earlier this month that it is retiring certain local coverage determinations (LCDs) and revising a few others.

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