LCD and Associated Billing and Coding Article Updates for July/August 2021

July 2021

Billing and Coding: Denosumab (Prolia ™, Xgeva ™) (A52399)
The following clarification has been added to the Documentation Requirements for Denosumab(Prolia®) and (Xgeva®): Patient adequately supplemented with calcium and vitamin D.

Self-Administered Drug Exclusion List: Medical Policy Article (A53021/A53022)
The article has been updated to add: J1826 (Avonex Pen®, Rebif®, Rebif® Rebidose®), Q3027 (Avonex®) and Q3028 (Rebif®) effective for dates of service on or after 9/1/2021.

August 2021

Biomarker Testing (Prior to Initial Biopsy) for Prostate Cancer Diagnosis (L37733)
Based on a Reconsideration Request, the Indication of Coverage for EPI test was expanded, based on the review of recently published literature, effective for services rendered on or after 8/1/2021.

Platelet Rich Plasma (L38937) and Billing and Coding: Platelet Rich Plasma (A58609)
This is a noncoverage policy for all platelet rich plasma injections and/or applications as a means of managing musculoskeletal injuries and/or joint conditions.

Billing and Coding: Bevacizumab and biosimilars (A52370)
Based on compendia review, ICD-10 codes G93.6 and Y84.2 have been added to the Group 1 ICD-10 code list effective for dates of service on or after 8/1/2021.

Billing and Coding: Bortezomib (A52371)
Based on compendia review, ICD-10 codes C83.51, C83.52, C83.53, C83.54, C83.55, C83.56, C83.57, C83.58 and C83.59 have been added to the Group 1 ICD-10 code list effective for dates of service on or after 8/1/2021.

Billing and Coding: Hyaluronans Intra-articular Injections of (A52420)
Based on compendia review, ICD-10 codes M75.41 and M75.42 have been added to the Group 1 ICD-10 code list effective for dates of service on or after 8/1/2021.

Billing and Coding: Intravenous Immune Globulin (IVIG) (A52446)
Based on compendia review, ICD-10 codes T80.89XA, T80.89XD and T80.89XS have been added to the Group 1 ICD-10 code list effective for dates of service on or after 8/1/2021.

Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™) (A52450)
Based on compendia review, ICD-10 code C21.2 has been added to the Group 2 ICD-10 code list for paclitaxel effective for dates of service on or after 8/1/2021.

Billing and Coding: Rituximab, biosimilars and Rituximab and hyaluronidase human (Rituxan Hycela™) (A52452)
The article has been updated to add HCPCS code Q5123 to the CPT/HCPCS Codes section of the article.

Posted 7/23/2021