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LCD and Billing and Coding Article Updates for November/December 2023

LCDs Effective 12/24/2023

Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound  (L39139/A58893)

This is a non-coverage policy for all amniotic membrane, amniotic fluid or other placental-derived product injections and/or applications as a means of managing musculoskeletal injuries, joint conditions. This guidance does not include discussion on burns, wounds or ophthalmic conditions.

Urine Drug Testing (L39611/A59416)

This LCD and related article is being revised as part of a collaborative process for consistency and clarity of coverage across all MAC regions.

November/December 2023 Updates to Billing and Coding Articles

Epidural Steroid Injections for Pain Management (L39036)

In response to an inquiry Limitation #12 has been revised to remove the following language: “it is recommended not to exceed 80 mg of triamcinolone, 12 mg of betamethasone, 15 mg of dexamethasone per session.”

Billing and Coding: Epidural Steroid Injections for Pain Management (A58745)

Documentation requirement #4 has been revised to indicate: SNRBs and TFESIs : The procedural report should clearly document the indications and medical necessity for the injections, along with the baseline pain score. SNRBs only: The procedural report should include the baseline pain score and percent (%) pain relief achieved immediately after the injection.

Home Health Skilled Nursing Care: Teaching and Training for Dementia Patients with Behavioral Disturbances – Medical Policy Article (A52845)

Article updated to list current HCPCS codes G0299 and G0300 which are replacing deleted code G0164.

Billing and Coding: Routine Foot Care and Debridement of Nails (A57759)

Provisions related to coverage of treatment of mycotic nails has been clarified. In addition, effective for dates of service on or after 12/1/2023, provisions for routine foot care foot care certification such as CFCN® or CFCS or other similar certifications or independent training by supervising professionals may perform have been added.

Billing and Coding: Nerve Conduction Studies and Electromyography (A57668)

Article revised to correct level of supervision to direct for these procedures:

“77” = “Procedure must be performed by a PT with CFCN® or ABPTS certification (TC and PC) or by a PT without certification under direct supervision of a physician (TC only; PC always physician)”. These changes are effective 1/1/2013.

Self-Administered Drug Exclusion List: Medical Policy Article (A53021/A53022)

The article has been updated to add “subcutaneous use*” for HCPCS codes J0801, J0802 and for Secukinumab (Cosentyx™) (C9399, J3590). The following new drugs have been added: Vedolizumab (Entyvio®) subcutaneous use* (C9399, J3490, J3590), Adalimumab-aaty (Yuflyma) (C9399, J3490, J3590) and Mirikizumab-mrkz (Omvoh™) subcutaneous use* (C9399, J3490, J3590) effective for dates of service on or after 1/14/2024.

Posted 11/29/2023