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LCD and Article Updates May/June 2024

Billing and Coding Articles

L37485 Prostate Rectal Spacers

This policy is retired and is no longer in effect for services rendered on or after 5/1/2024.

A52863 Billing and Coding: Pain Management - injection of tendon sheaths, ligaments, ganglion cysts, carpal and tarsal tunnels

This article is being revised only to correct a typographical error in the Revision History. Effective 4/01/2024, all references to trigger point injection procedures have been removed. Please refer to Article A59487 - Billing and Coding: Trigger Point Injections (TPI).

A56539 Prostate Rectal Spacers

This article is retired and is no longer in effect for services rendered on or after 5/1/2024.

A59233 Billing and Coding: Sacroiliac Joint Injections and Procedures

Under Coding Guidance, Diagnostic and Therapeutic procedures, 6th paragraph, removed “G0260 should be reported with an imaging code specific to the imaging modality employed" and "Report CPT 77002 for fluoroscopic guidance or CPT 77012 for CT guidance in the ASC and the hospital outpatient department” and added, “The medical record must contain documentation that fluoroscopic guidance or CT guidance was used with HCPCS code G0260" and "Image guidance is packaged into G0260, and no separate payment is made to the ASC or OPPS hospital outpatient department for CPT codes 77002 and 77012.”

Under CPT/HCPCS Codes Group 3 Paragraph, verbiage was revised to read, "For ASC facility and OPPS hospital outpatient department claims only:" Under Group 3 Codes CPT 77002 and 77012 were deleted. Under ICD-10-CM Codes that Support Medical Necessity Group 1: Paragraph, verbiage was added “CPT codes 27096, 64451 and HCPCS code G0260.”

These updates are effective 1/25/2024.

A53021 Self-Administered Drug Exclusion List: Medical Policy Article

The article has been updated to add: Semaglutide (Wegovy®) (C9399, J3590), Tirzepatide (Zepbound®) (C9399, J3490, J3590), and moved Liraglutide (Saxenda®) to be on the same rows as Liraglutide (Victoza®) (C9399, J3490, J3590). Effective for dates of service on or after 5/16/2024.

Posted 5/23/2024