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April 2022 LCD and Billing and Coding Article Updates

LCDs Effective 4/1/2022

Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA) (L33559/A56737)

The LCD was returned for comment from 6/3/2021 through 7/17/2021, to remove references to fractional flow reserve (FFR) services from the LCD. FFR provisions were moved to a new LCD, L39075, effective 4/1/2022.

Based on a comment received, the requirement for a certified registered nurse to supervise the use of intravenous beta blockers or nitrates given prior to a CT coronary angiogram was removed from limitations for the technical portion of the CCTA test.

Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms  (L37810/A56787)

Based on receipt of Reconsideration Requests, limited coverage of Next-Generation Sequence (NGS) Comprehensive Genomic Profile (CGP) Testing language was added throughout the LCD.

Non-Invasive Fractional Flow Reserve (FFR) for Stable Ischemic Heart Disease (L39075/A58841)

This is a new LCD with limited coverage for FFR when done after a base study (CCTA) has been completed and interpreted.

Billing and Coding articles effective 4/1/2022

Billing and Coding: Bevacizumab and biosimilars (A52370)

Based on compendia review, ICD-10 code C45.7 has been added to Group 1 ICD-10 code list effective for dates of service on or after 4/1/2022.

Billing and Coding: Filgrastim, Pegfilgrastim, Tbo-filgrastim and biosimilars (A52408)

Based on compendia review, ICD-10 codes T80.82XA, T80.82XS, T80.89XA and T80.89XS have been added to Group 4 ICD-10 code list effective for dates of service on or after 4/1/2022.

Billing and Coding: Intravenous Immune Globulin (IVIG) (A52446)

Based on compendia review, ICD-10 codes D89.834, G62.0, I30.8, T80.82XA and T80.82XS have been added to Group 1 ICD-10 code list effective for dates of service on or after 4/1/2022.

Billing and Coding: Molecular Pathology Procedures (A56199)

The following, underlined language was added to the Correct Coding of Molecular Testing Panels under Specific Coding of Molecular Testing Panels in the Article text:

CPT code 81455 should be billed when 51 or greater genes are ordered for molecular biomarkers. Please refer to Local Coverage Determination L37810 Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms and the associated Article A56867

CPT code 81455 was removed from CPT/HCPCS Code section-Group 3.

Billing and Coding: Nivolumab (A54862)

Based on compendia review, ICD-10 code C45.1, C45.2 and C45.7 have been added to Group 1 ICD-10 code list effective for dates of service on or after 4/1/2022.

Billing and Coding: Ranibizumab, Aflibercept and Brolucizumab-dbll and Faricimab-svoa (A52451)

Based on Transmittal 11268 (CR12623) Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - April 2022 Update - HCPCS code Q5124 (ranibizumab-nuna, biosimilar, (Byooviz) has been added to the CPT/HCPCS Codes Group 1 Paragraph section. Reference to ranibizumab-nuna, biosimilar, (Byooviz) has been added to the ICD-10-CM Codes that Support Medical Necessity Group 1 Paragraph section. HCPCS code J3590 has been added to the CPT/HCPCS Codes Group 1 Paragraph section for Faricimab-svoa (Vabysmo™) and Group 4 has been added for payable ICD-10-CM codes for Faricimab-svoa (Vabysmo™) effective for dates of service on or after 1/28/2022.

Billing and Coding: Stem Cell Transplantation (A52879)

Based on Transmittal 11068, Change Request 12480 - International Classification of Diseases International Classification of Diseases April 2022, ICD-10 codes C47.9, C72.50, C72.9, C81.91, C81.92, C81.93, C81.94, C81.95, C81.96, C81.97, C81.98, C81.99, C85.91, C85.92, C85.93, C85.94, C85.96, C85.97, C85.98, C85.99, C95.91, C96.20, C93.91, C92.91, C91.91 and C96.9 have been removed from the Group 2 list effective 4/1/2022. ICD-10 code C85.95 has also been removed from the Group 2 list effective 4/1/2022.

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

The article has been updated to add: Risankizumab-rzaa (Skyrizi™) (C9399, J3490, J3590) effective for dates of service on or after 5/15/2022.

Posted 3/25/2022