December 2021-January 2022 LCD and Billing and Coding Article Updates
Billing and Coding: Autonomic Function Testing (A57024)
Due to the annual CPT/HCPCS code updates, effective 1/1/2022, CPT code 95943 has been deleted from the CPT/HCPCS code sections – Group 2.
CPT code 95999 has been added to the CPT/HCPCS code sections – Group 2. CPT code 95999 should be used to report testing other than autonomic nervous system function testing.
Billing and Coding: Cardiac Catheterization and Coronary Angiography (A52850)
Based on the annual CPT/HCPCS updates for 2022, CPT codes 93530, 93531, 93532 and 93533 have been deleted and replaced by codes 93593, 93594, 93595, 93596, 93597 and 93598 for evaluation of congenital heart defects. CPT codes 93561 and 93562 have been deleted and replaced by code 93598 for cardiac output measurement.
Billing and Coding: Colon Capsule Endoscopy (CCE) (A58294)
Due to the 2022 annual CPT updates, code 0355T has been deleted and replaced by code 91113.
Billing and Coding: Complex Drug Administration Coding (A58620)
Under Subcutaneous and Intramuscular Injection Non-Chemotherapy Generic/Trade Names table added J2506 pegfilgrastim, excludes biosimilar (Neulasta®) and removed J2505 pegfilgrastim (Neulasta®) due to CPT/HCPCS updates effective 1/1/2022. The following statements were removed: “*Note: The self-administration formulation of certolizumab pegol (Cimzia® prefilled syringe as a 200 mg/1 ml unit dose) is not a Medicare benefit. Providers and facilities must bill this formulation with the GY modifier as a statutorily excluded service” and “The subcutaneous or intravenous formulation of octreotide acetate is billed using HCPCS code J2354 with the JA (intravenous) or JB (subcutaneous) modifier.” Under Infusions Non-Chemotherapy Generic/Trade Names table added J3590 Anifrolumab-fnia (SaphneloTM ). Under CPT/HCPCS Codes Group 1 Paragraph removed the following statements: “J0717: The self-administration formulation of certolizumab pegol (Cimzia® prefilled syringe as a 200 mg/1 ml unit dose) is not a Medicare benefit. Providers and facilities must bill this formulation with the GY modifier as a statutorily excluded service” and “J2505: Effective 1/1/2018 providers are instructed to use 96377 for the on body application injector for Neulasta® Onpro Kit.” Group 1 Codes added J2506 and removed J2505. Group 2 Codes added J3590. Minor grammatical and formatting errors corrected. These changes are effective 2/13/2022
Billing and Coding: Epidural Steroid Injections for Pain Management (A58745)
The language in the following Utilization guideline has been revised for clarity:
No more than 4 epidural injection sessions (CPT codes 62321, 62323, 64479, 64480, 64483 or 64484) may be reported per spinal region in a rolling 12-month period regardless of the number of levels involved.
Billing and Coding: Filgrastim, Pegfilgrastim, Tbo-filgrastim and biosimilars (A52408)
Based on the annual CPT/HCPCS update, HCPCS code J2506 has been added to the “CPT/HCPCS Codes” section of the article and will replace deleted HCPCS code J2505.
Billing and Coding: Hypoglossal Nerve Stimulation for Treatment of Obstructive Sleep Apnea (A57092)
Based on the annual CPT/HCPCS update, CPT codes 64568 and 0466T have been replaced with CPT code 64582, and CPT codes 0467T and 0468T have been replaced with CPT codes 64583 and 64584. Modifier 52 has been added to the CPT/HCPCS Modifiers section of the article.
Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs (A52453)
Based on the annual CPT/HCPCS update, the description for CPT code 11981 has been revised. HCPCS code J1952 has been added to the “CPT/HCPCS Codes” section of the article. Information regarding leuprolide mesylate (Cancevi®) has been added throughout the article. Group 13 has been added to the “ICD-10-CM that Support Medical Necessity” section of the article for leuprolide mesylate (Cancevi®).
Billing and Coding: Micro-Invasive Glaucoma Surgery (MIGS) (A56588)
Due to the annual CPT code update, effective 1/1/2022, CPT codes 0191T and 0376T are being replaced by codes 66989 and 66991. CPT codes 66989 and 66991 were added to Group 1 – CPT/HCPCS coding section.
CPT code 0191T was deleted from Group1 – CPT/HCPCS coding section, and 0376T was deleted from Group2 – CPT HCPCS coding section.
CPT code 0671T was added to Group 2–CPT/HCPCS coding section.
Billing and Coding: Molecular Pathology Procedures (A56199)
Due to the annual CPT/HCPCS code update, CPT code 81523 was added to the CPT/HCPCS Codes section – Group 1, and CPT code 81349 was added to the CPT/HCPCS Codes section – Group 3.
CPT codes 81522 and 81523 were added to the “ICD-10-CM Codes that Support Medical Necessity” section – Group 26 paragraph, effective for services rendered on or after 1/1/2022.
Billing and Coding: Nivolumab (A54862)
Based on compendia review, ICD-10 codes C53.0, C53.1 and C53.8 have been added effective for dates of service on or after 01/01/2022.
Billing and Coding: Respiratory Pathogen Panel Testing (A58741)
Due to the annual CPT/HCPCS code updates the long code description for 87428 has been changed.
Billing and Coding: Thyroid Nodule Molecular Testing (A58656)
Due to the annual CPT/HCPCS code update, PLA code 0208U was deleted from CPT/HCPCS Codes section – Group 2, effective for services performed after 12/31/2021.
Billing and Coding: Transesophageal Echocardiography (TEE) (A52868)
Due to the 2022 annual CPT updates, CPT code 93319 has been added to the list of codes, guidelines, and to Groups 1 and 2 ICD-10 covered diagnoses.
Billing and Coding: Transthoracic Echocardiography (TTE) (A56781)
Due to the 2022 annual CPT updates, CPT code 93319 has been added to the list of codes, guidelines, and to Group 2 ICD-10 covered diagnoses.
Posted 12/23/2021