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Revised LCDs and Articles: April–May 2018

April 2018 Revised LCDs and Articles

Filgrastim, Pegfilgrastim, Tbo-filgrastim, Filgrastim-sndz (e.g., Neupogen®, Neulasta ™, Granix ™ Zarxio™) - Related to LCD L33394 (A52408)

Based on Transmittal 3966 - Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes - April 2018 Update, the description for HCPCS code Q5101 has changed and use of the ZA modifier has been discontinued effective 4/1/2018.

ICD-10-CM codes Z48.290 and Z94.81 have been added to the Group 1 codes for pegfilgrastim effective for dates of service on or after 5/3/2018. ICD-10-CM codes C93.00, C93.02, C93.10, C94.00, C94.02, C94.20 and C94.22 have been added to the Group 4 codes for filgrastim effective for dates of service on or after 5/3/2018. An indication for anemia in myelodysplastic syndrome; in combination with epoetin has been added to the “Indications” section for Tbo-filgrastim.ICD-10-CM codes C93.10, D46.0, D46.1, D46.20, D46.21, D46.A, D46.B, D46.4, D46.Z, D46.9, Z48.290 and Z94.81 have been added to the Group 5 codes for Tbo-filgrastim effective for dates of service on or after 05/03/2018.

Hyaluronans Intra-articular Injections of - Related to LCD L33394 (A52420)

Based on Transmittal 3988 - April 2018 Update of the Hospital Outpatient Prospective Payment System (OPPS), HCPCS code C9465 has been added effective for dates of service on or after 4/1/2018. HCPCS code J3490 should be used to report Durolane® when billed to the Part B MAC. Durolane® has been added throughout the article.

Infliximab, Infliximab-dyyb, Infliximab-abda (e.g., Remicade™, Inflectra™, Renflexis) – Related to LCD L33394 (A52423)

Based on Transmittal 3966 - Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes – April 2018 Update, HCPCS code Q5102 has been deleted and replaced with HCPCS codes Q5103 and Q5104 and use of modifiers ZB and ZC have been discontinued effective for dates of service on or after 4/1/2018.

May 2018 Revised LCDs and Articles

Drugs and Biologicals, Coding Article (A52855)

The paragraph for “Drugs with No Charges” has been revised and moved under the heading “For Claims Submitted to the Part B MAC.”

Hyaluronans Intra-articular Injections of - Related to LCD L33394 (A52420)

CPT code 20611 has been added to the “Coding Information” section guidelines 1 and 2.

Lumbar Epidural Injections (L35937)

ICD-10-CM code M48.061 has been added effective for dates of service on or after 10/1/2017.

Luteinizing Hormone-Releasing Hormone (LHRH) Analogs – Related to LCD L33394 (A52453)

The following indications have been added for luprolide acetate (HCPCS codes J1950 and J1270): /p>

  • Ovarian cancer/fallopian tube cancer/primary peritoneal cancer - epithelial ovarian cancer - malignant sex cord-stromal tumors (J1950)
  • Head and neck cancers-salivary gland tumors (J9217)

The following ICD-10-CM codes have been added to the Group 1 code list: C48.1, C48.8, C56.1, C56.2, C57.01-C57.02, C57.11-C57.12, C57.21 – C57.22, C57.3, C57.4 and C57.7-C57.8 and the following ICD-10-CM codes have been added to the Group 6 code list: C07, C08.0 and C08.1 effective for dates of service on or after 5/10/2018.

Magnetic Resonance Angiography (MRA) (L33633)

LCD revised to add sources submitted for a reconsideration request to add “history of aneurysm” to Indications and a diagnosis code for personal history of other diseases of the circulatory system to covered ICD-10 codes for MRA of the head/neck. No change was made in coverage.

Nivolumab - Related to LCD L33394 (A54862)

Indications for intermediate or poor risk, previously untreated advanced renal cell carcinoma, in combination with ipilimumab (Effective 4/16/2018 based on FDA approval and an indication for uveal melanoma – metastatic or unresectable disease as a single agent or in combination with ipilimumab have been added to the “Indications” section of the article.

ICD-10-CM codes C69.61 and C69.62 have been added effective for dates of service on or after 5/10/2018.

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

Uveal melanoma has been added to the “Indications” for paclitaxel and albumin-bound paclitaxel. ICD-10-CM codes C69.31, C69.32, C69.41, C69.42, C69.61 and C69.62 have been added to the Group 1 and Group 2 code lists for paclitaxel and albumin-bound paclitaxel effective for dates of service on or after 5/3/2018.

Rituximab (Rituxan®) - Related to LCD L33394 (A52452)

Based on a provider/practitioner request, ICD-10-CM code D89.811 has been added effective 10/1/2015.

Self-Administered Drug Exclusion List - Medical Policy Article JK (A53021) and J6 (A53022)

The article has been updated to correct the SAD Process URL.

Revised LCDs and Articles: April-May 2018
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