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Local Coverage Determination and Article Revisions: August 2019

The medical policies and related articles can be found in our Medical Policy Center.

LCD Revisions for August 2019

Please note that consistent with Change Request 10901, all coding information, national coverage provisions and Associated Information (Documentation Requirements, Utilization Guidelines) have been removed from the LCDs listed below and placed in related Billing and Coding Articles. These articles have been created or updated to accompany each LCD. The article numbers are included in the information below:

Cardiac Catheterization and Coronary Angiography (L33557) (A52850)

Consistent with Change Request 10901, all coding information, national coverage provisions and Associated Information (Documentation Requirements, Utilization Guidelines) have been removed from the LCD and placed in the related Billing and Coding Article, A52850. There has been no change in coverage with this LCD revision.

Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA) (L33559) (A52851)

Consistent with Change Request 10901, all coding information, national coverage provisions and Associated Information (Documentation Requirements, Utilization Guidelines) have been removed from the LCD and placed in the related Billing and Coding Article, A52851. There has been no change in coverage with this LCD revision.

Cardiovascular Nuclear Medicine (L33560) (A56743)

Consistent with Change Request 10901, all coding information, national coverage provisions and Associated Information (Documentation Requirements, Utilization Guidelines) have been removed from the LCD and placed in the related Billing and Coding Article, A56743. There has been no change in coverage with this LCD revision.

Cataract Extraction (L33558) (A56554)

Consistent with Change Request 10901, all coding information, national coverage provisions and Associated Information (Documentation Requirements, Utilization Guidelines) have been removed from the LCD and placed in the related Billing and Coding Article, A56554. There has been no change in coverage with this LCD revision.

Corneal Pachymetry (L33630) (A56548)

Consistent with Change Request 10901, all coding information, national coverage provisions and Associated Information (Documentation Requirements, Utilization Guidelines) have been removed from the LCD and placed in the related Billing and Coding Article, A56548. There has been no change in coverage with this LCD revision.

Debridement Services (L33614) (A56617)

Consistent with Change Request 10901, all coding information, national coverage provisions and Associated Information (Documentation Requirements, Utilization Guidelines) have been removed from the LCD and placed in the related Billing and Coding Article, A56617. There has been no change in coverage with this LCD revision.

To provide clarity the following sentence was added to Coverage Limitations:

Debridement area greater than 10% is limited to those practitioners who are licensed to perform surgery above the ankle, since the amount of skin required is more than that contained on both feet.

Incision and Drainage (I&D) of Abscess of Skin, Subcutaneous and Accessory Structures (L33563) (A56766)

Consistent with Change Request 10901, all coding information, national coverage provisions and Associated Information (Documentation Requirements, Utilization Guidelines) have been removed from the LCD and placed in the related Billing and Coding Article, A56766. There has been no change in coverage with this LCD revision.

Magnetic Resonance Angiography (MRA) (L33633) (A56747)

Consistent with Change Request 10901, all coding information, national coverage provisions and Associated Information (Documentation Requirements, Utilization Guidelines) have been removed from the LCD and placed in the related Billing and Coding Article, A56747. There has been no change in coverage with this LCD revision.

Non-Invasive Vascular Studies (L33627) (A56758)

Consistent with Change Request 10901, all coding information, national coverage provisions and Associated Information (Documentation Requirements, Utilization Guidelines) have been removed from the LCD and placed in the related Billing and Coding Article, A56758. There has been no change in coverage with this LCD revision.

Nonvascular Extremity Ultrasound (L33619) (A56787)

Consistent with Change Request 10901, all coding information, National coverage provisions and Associated Information (Documentation Requirements, Utilization Guidelines) have been removed from the LCD and placed in the related Billing and Coding Article, A56787. There has been no change in coverage with this LCD revision.

Ophthalmic Biometry for Intraocular Lens Power Calculation (L33621) (A56549)

Consistent with Change Request 10901, all coding information, National coverage provisions and Associated Information (Documentation Requirements, Utilization Guidelines) have been removed from the LCD and placed in the related Billing and Coding Article, A56549. There has been no change in coverage with this LCD revision.

Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography) (L33567) (A56678)

Consistent with Change Request 10901, all coding information, National coverage provisions and Associated Information (Documentation Requirements, Utilization Guidelines) have been removed from the LCD and placed in the related Billing and Coding Article, A56678. There has been no change in coverage with this LCD revision.

Pain Management (L33622) (A52863)

Consistent with Change Request 10901, all coding information, National coverage provisions and Associated Information (Documentation Requirements, Utilization Guidelines) have been removed from the LCD and placed in the related Billing and Coding Article, A52863. There has been no change in coverage with this LCD revision.

Panretinal (Scatter) Laser Photocoagulation (L33628) (A56550)

Consistent with Change Request 10901, all coding information, National coverage provisions and Associated Information (Documentation Requirements, Utilization Guidelines) have been removed from the LCD and placed in the related Billing and Coding Article, A56550. There has been no change in coverage with this LCD revision.

Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI) (L34380) (A56537)

Consistent with Change Request 10901, all coding information, National coverage provisions and Associated Information (Documentation Requirements, Utilization Guidelines) have been removed from the LCD and placed in the related Billing and Coding Article, A56537. There has been no change in coverage with this LCD revision.

The following ICD-10-CM codes were added to the related Billing and Coding Article,  (A56537) to support the medical necessity of CPT code 92134- Group 3, effective for services rendered on or after 8/1/2019: H33.301- H33.303; H33.311- H33.313; H33.321- H33.323; H33.331- H33.333.

Transesophageal Echocardiography (TEE) (L33579) (A52868)

Consistent with Change Request 10901, all coding information, National coverage provisions and Associated Information (Documentation Requirements, Utilization Guidelines) have been removed from the LCD and placed in the related Billing and Coding Article, A52868. There has been no change in coverage with this LCD revision.

Transthoracic Echocardiography (TTE) (L33577) (A56781)

Consistent with Change Request 10901, all coding information, National coverage provisions and Associated Information (Documentation Requirements, Utilization Guidelines) have been removed from the LCD and placed in the related Billing and Coding Article, A56781. There has been no change in coverage with this LCD revision.

Treatment of Varicose Veins of the Lower Extremity (L33575) (A52870)

Consistent with Change Request 10901, all coding information, National coverage provisions and Associated Information (Documentation Requirements, Utilization Guidelines) have been removed from the LCD and placed in the related Billing and Coding Article, A52870. There has been no change in coverage with this LCD revision.

Visual Fields Testing (L33574) (A56551)

Consistent with Change Request 10901, all coding information, National coverage provisions and Associated Information (Documentation Requirements, Utilization Guidelines) have been removed from the LCD and placed in the related Billing and Coding Article, A56551. There has been no change in coverage with this LCD revision.

Urine Drug Testing (L36037) (A56761)

Consistent with Change Request 10901, all coding information, National coverage provisions, and Associated Information (Documentation Requirements, Utilization Guidelines) have been removed from the LCD and placed in the related Billing and Coding Article, A56761. There has been no change in coverage with this LCD revision.

Article revisions

Bevacizumab - Related to LCD L33394 (A52370)

Based on compendia review, ICD-10-CM code C85.89 has been added to the Group 1 code list effective for dates of service on or after 08/01/2019.

Bortezomib – Related to LCD L33394(A52371)

Based on compendia review, ICD-10-CM code D47.Z2 has been added effective for dates of service on or after 08/01/2019.

Filgrastim, Pegfilgrastim, Tbo-filgrastim and biosimilars - Related to LCD L33394(A52408)

Based on compendia review, the following updates have been made. The indications below have been added for filgrastim, filgrastim-sndz and filgrastim-aafi:

    • for patients who present with acute exposure to myelosuppressive doses of radiation
    • hematopoietic cell transplant for
      • mobilization of hematopoietic progenitor cells in combination with plerixafor in the autologous setting for patients with non-Hodgkin lymphoma or multiple myeloma
      • mobilization of donor hematopoietic progenitor cells (preferred) or for granulocyte transfusion in the allogeneic setting
      • supportive care in the post-transplant setting

ICD-10-CM codes T66.XXXA, T66.XXXD and T66.XXXS have been added to Group 4 for filgrastim, filgrastim-sndz and filgrastim-aafi effective for dates of service on or after 08/01/2019.

The following indication has been added for Tbo-filgrastim:

    • for patients who present with acute exposure to myelosuppressive doses of radiation

ICD-10-CM codes T66.XXXA, T66.XXXD and T66.XXXS have been added to Group 5 for Tbo-filgrastim effective for dates of service on or after 08/01/2019.

Intravenous Immune Globulin (IVIG) - Related to LCD L33394(A52446)

ICD-10-CM codes D80.2, D80.4, D80.6, D80.7, D81.5, D82.1, D82.4, D83.1 and G11.3 have been added effective for dates of service on or after 08/13/2019 based on updates made in Transmittal 259.

Nivolumab - Related to LCD L33394(A54862)

Based on compendia review, ICD-10-CM code C7A.1 has been added effective for dates of service on or after 08/01/2019.

Paclitaxel (e.g., Taxol®/Abraxane) - Related to LCD L33394(A52450)

Based on compendia review, an indication for gastric cancer, refractory to first line fluoropyrimidine-containing chemotherapy has been added for albumin-bound paclitaxel. ICD-10-CM codes C16.0, C16.1, C16.2, C16.3, C16.4, C16.5, C16.6, C16.8 and D37.1 have been added effective for dates of service on or after 08/01/2019. An indication for cutaneous melanoma has been added for paclitaxel.

[Return to Medicare Monthly Review Index]

associated information
08/19 MMR: Local Coverage Determination and Article Revisions: August 2019
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