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National Government Services Local Coverage Determinations

Welcome to Medical Policies. Below you will find the LCDs, related billing & coding articles and additional medical policy topics. When entering criteria into the search box, the search results will be conducted within the LCDs and the Medical Policy Articles shown below. For additional Medical Policy Topics, refer to the bottom of the page.

[View Draft Policies | View Future Effective LCDs | View Future Effective Billing & Coding Articles | National Coverage Determinations]

Local Coverage Determinations

LCD LCD # Billing and Coding # Response to Comments Related CPT/HCPCS Codes
Autonomic Function Testing
Related terms: tilt table, sudomotor
L36236 A57024 A54403 95921, 95922, 95923, 95924, 95943
B-type Natriuretic Peptide (BNP) Testing
Related terms: congestive heart failure, acute dyspnea
L33573 A56826 83880
Biomarker Testing (Prior to Initial Biopsy) for Prostate Cancer Diagnosis
Related terms: N/A
L37733 A56609 A56742 81539, 84153, 84154, 86316, 81479, 0005U
Biomarker Testing for Neuroendocrine Tumors/Neoplasms
Related terms: N/A
L37851 A57059 A56247 0007M
Botulinum Toxins
Related terms: Botox, Myobloc, Dysport,Xeomin, spasticity, chemodenervation
L33646 A52848 43201, 43236, 46505, 52287, 64611, 64612, 64615, 64616, 64617, 64642, 64643, 64644, 64645, 64646, 64647, 64650, 64653, 67345, J0585, J0586, J0587, J0588
Breast Imaging: Breast Echography (Sonography)/Breast MRI/Ductography
Related terms: ultrasound, non-palpable masses, palpable masses
L33585 A52849 19030, 76641, 76642, 77046, 77047, 77048, 77049, 77053, 77054, C8903, C8905, C8906, C8908
Cardiac Catheterization and Coronary Angiography
Related terms: heart, circulatory
L33557 A52850 36120, 36140, 36200, 36215, 36216, 36217, 36218, 36245, 36246, 36247, 36248, 36251, 36252, 36253, 36254, 75625, 75630, 75658, 75705, 75710, 75716, 92978, 92979, 93451, 93452, 93453, 93454, 93455, 93456, 93457, 93458, 93459, 93460, 93461, 93462, 93463, 93464, 93505, 93530, 93531, 93532, 93533, 93561, 93562, 93563, 93564, 93565, 93566, 93567, 93568, 93571, 93572, G0269, G0278
Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA)
Related terms: heart, calcium, congenital, bypass
L33559 A56737 75571, 75572, 75573, 75574, 0501T, 0502T, 0503T, 0504T
Cardiovascular Nuclear Medicine
Related terms: cardiac scan, stress test, heart, coronary, ejection, perfusion, blood pool
L33560 A56743 78451, 78452, 78453, 78454, 78466, 78468, 78469, 78472, 78473, 78481, 78483, 78494, 78496, A9500, A9501, A9502, A9505, A9512, A9520, A9538, A9560, Q9969
Cataract Extraction
Related terms: eyes, ophthalmology, complex, epinephrine
L33558 A56544 A55257 66840, 66850, 66852, 66920, 66930, 66940, 66982, 66983, 66984, 66987, 66988
Colon Capsule Endoscopy (CCE)
Related terms: N/A
L38571 A58294 A58630
Computed Tomographic (CT) Colonography for Diagnostic Uses
Related terms: virtual colonoscopy
L33562 A57026 74261, 74262
Computed Tomography Cerebral Perfusion Analysis (CTP)
Related terms: N/A
L38667 A58152 A58327 0042T
Corneal Hysteresis
Related terms: N/A
L38014 A56528 A56529 92145
Corneal Pachymetry
Related terms: cornea, ophthalmology, eyes
L33630 A56548 76514, 92499
Debridement Services
Related terms: N/A
L33614 A56617 11000, 11001, 11042, 11043, 11044, 11045, 11046, 11047, 97597, 97598
Drugs and Biologicals, Coverage of, for Label and Off-Label Uses
Related terms: administration, compendia, FDA
L33394 A52855
EEG – Ambulatory Monitoring
Related terms: electroencephalogram
L33399 A57030 95700, 95705, 95706, 95707, 95708, 95709, 95710, 95711, 95712, 95713, 95714, 95715, 95716, 95717, 95718, 95719, 95720, 95721, 95722, 95723, 95724, 95725, 95726
Facet Joint Interventions for Pain Management
Related terms: Radiofrequency, Neurotomy, pain, cervical, lumbar, thoracic
L35936 A57826 64490, 64491, 64492, 64493, 64494, 64495, 64633, 64634, 64635, 64636, 64625
Fluid Jet System Treatment for LUTS/BPH
Related terms: N/A
L38367 A56797 A58465 C2596, 0421T
Frequency of Hemodialysis
Related terms: dialysis, kidney disease, end stage renal disease
L37475 A55672 A56252 90999
Genomic Sequence Analysis Panels in the Treatment of Hematolymphoid Diseases
Related terms: N/A
L37606 A56793 A55974 81450
Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms
Related terms: N/A
L37810 A56867 A56216 0048U, 81445
Heavy Metal Testing
Related terms: metal toxicity, aluminum, arsenic, iron, lead, nickel, zinc, mercury
L35074 A56767 A58628 82108, 82175, 82300, 82495, 82525, 83015, 83018, 83655, 83785, 83825, 83885, 84255, 84285, 84630, 84999
Hospice - Determining Terminal Status
Related terms: Decline, life expectancy
L33393 A52830
Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea
Related terms: N/A
L38387 A57092 64568, 0466T, 0467T, 0468T
Implantable Continuous Glucose Monitors (I-CGM)
Related terms: N/A
L38623 A58116 A58342 0446T, 0447T, 0448T
Implantable Miniature Telescope (IMT)
Related terms: eye, blindness
L33584 A57411 A55261 C1840, 0308T
Incision and Drainage (I & D) of Abscess of Skin, Subcutaneous and Accessory Structures
Related terms: paronychia, skin, carbuncle, boil
L33563 A56766 10060, 10061, 10080, 10081, 10140, 10160, 10180
Lumbar Epidural Injections
Related terms: spine, pain, transforaminal, sacral, steroid, spinal
L35937 A57494 62322, 62323, 62326, 62327, 64483, 64484
Magnetic Resonance Angiography (MRA)
Related terms: gadolinium, contrast, imaging
L33633 A56747 70544, 70545, 70546, 70547, 70548, 70549, 71555, 72159, 72198, 73225, 73725, 74185, C8900, C8901, C8902, C8909, C8910, C8911, C8912, C8913, C8914, C8918, C8919, C8920, C8931, C8932, C8933, C8934, C8935, C8936
Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Tremor
Related terms: N/A
L37421 A57435 A58546 0398T
Micro-Invasive Glaucoma Surgery (MIGS)
Related terms: N/A
L37244 A56588 A56783 0191T, 0376T, 0449T, 0450T, 0474T
Minimally-invasive Surgical (MIS) Fusion of the Sacroiliac (SI) Joint
Related terms: iFuse
L36406 A57431 27279
Molecular Pathology Procedures
Related terms: genetic testing, genetic counseling, gene, Tier 1, Tier 2
L35000 A56199 A55982 81120, 81121, 81162, 81163, 81164, 81165, 81166, 81167, 81170, 81175, 81176, 81206, 81207, 81208, 81209, 81210, 81212, 81215, 81216, 81217, 81218, 81219, 81220, 81221, 81222, 81223, 81224, 81225, 81226, 81235, 81236, 81237, 81245, 81246, 81256, 81261, 81262, 81263, 81264, 81265, 81266, 81267, 81268, 81270, 81272, 81273, 81275, 81276, 81287, 81301, 81305, 81307, 81308, 81309, 81310, 81311, 81313, 81314, 81315, 81316, 81332, 81334, 81335, 81340, 81341, 81342, 81345, 81370, 81371, 81372, 81373, 81374, 81375, 81376, 81377, 81378, 81379, 81380, 81381, 81382, 81383, 81518, 81519, 81520, 81595, 81177, 81178, 81179, 81180, 81181, 81182, 81183, 81184, 81185, 81186, 81187, 81188, 81189, 81190, 81233, 81288, 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299, 81300, 81306, 81312, 81317, 81318, 81319, 81320, 81321, 81322, 81323, 81333, 81343, 81344, 81599, 81105‒81112, 81161, 81171, 81172, 81173, 81174, 81200, 81201, 81202, 81203, 81204, 81205, 81227, 81228, 81229, 81230, 81231, 81232, 81234, 81238, 81239, 81240, 81241, 81242, 81243, 81244, 81247, 81248, 81249, 81250, 81251, 81252, 81253, 81254, 81255, 81257, 81258, 81259, 81260, 81269, 81271, 81274, 81277, 81283, 81284, 81285, 81286, 81289, 81290, 81291, 81302, 81303, 81304, 81324, 81325, 81326, 81327, 81328, 81329, 81330, 81331, 81336, 81337, 81346, 81350, 81355, 81361‒81364, 81410, 81411, 81412, 81413, 81414, 81415, 81416, 81417, 81420, 81422, 81425, 81426, 81427, 81430, 81431, 81432, 81433, 81434, 81435, 81436, 81437, 81438, 81439, 81440, 81442, 81443, 81448, 81455, 81460, 81465, 81470, 81471, 81493, 81500, ,81503, 81504, 81507, 81521, 81522, 81525, 81535, 81536, 81538, 81540, 81541, 81542, 81545, 81551, 81552
Multimarker Serum Tests Related to Ovarian Cancer Testing
Related terms: N/A
L38371 A57020 A58112 81500, 81503, 0003U
Nerve Conduction Studies and Electromyography
Related terms: electrodiagnostic, neurologic, EMG, NCS, neuromuscular, motor, needle
L35098 A57668 51785, 92265, 95860, 95861, 95863, 95864, 95865, 95866, 95867, 95868, 95869, 95870, 95872, 95873, 95874, 95885, 95886, 95887, 95905, 95907, 95908, 95909, 95910, 95911, 95912, 95913, 95933, 95937, 95999, G0255
Noninvasive Vascular Studies
Related terms: NonInvasive, leg, clot, plethysmography, duplex scan, Doppler, cerebrovascular, arterial, venous, hemodialysis
L33627 A56758 93880, 93882, 93886, 93888, 93890, 93892, 93893, 93922, 93923, 93924, 93925, 93926, 93930, 93931, 93970, 93971, 93975, 93976, 93978, 93979, 93970, 93971, 93985, 93986, 93990
Nonvascular Extremity Ultrasound
Related terms: clot, plantar fasciitis
L33619 A56787 76881, 76882
Ophthalmic Biometry for Intraocular Lens Power Calculation
Related terms: cataract, biometry, eyes
L33621 A56549 76519, 92136
Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
Related terms: retinal, retinopathy, chorioretinitis, vitreous
L33567 A56726 92201, 92202, 92227, 92228, 92250
Osteopathic Manipulative Treatment
Related terms: somatic, skeletal, dysfunction
L33616 A56954 A55318 98925, 98926, 98927, 98928, 98929
Outpatient Physical and Occupational Therapy Services
Related terms: maintenance, restorative, skilled, modality, therapeutic, exercise, manual, cast, splint, biofeedback
L33631 A56566 29065, 29075, 29085, 29086, 29105, 29125, 29126, 29130, 29131, 29200, 29240, 29260, 29280, 29345, 29355, 29365, 29405, 29425, 29445, 29505, 29515, 29520, 29530, 29540, 29550, 29580, 29799, 90901, 90912, 90913, 95851, 95852, 95992, 96125, 97010, 97012, 97016, 97018, 97022, 97024, 97026, 97028, 97032, 97033, 97034, 97035, 97036, 97039, 97110, 97112, 97113, 97116, 97124, 97129, 97130, 97139, 97140, 97150, 97161, 97162, 97163, 97164, 97165, 97166, 97167, 97168, 97530, 97533, 97535, 97537, 97542, 97602, 97605, 97606, 97607, 97608, 97750, 97755, 97760, 97761, 97763, 97799, G0281, G0283, G0295, G0329
Pain Management
Related terms: spine, spinal, trigger, injection, ganglion
L33622 A52863 20526, 20550, 20551, 20552, 20553, 20560, 20561, 20612, 27096, 28899, 64451, 64625, G0260
Panretinal (Scatter) Laser Photocoagulation
Related terms: N/A
L33628 A56550 67228
Percutaneous Arteriovenous Fistula (pAVF) for Hemodialysis
Related terms: N/A
L38573 A58037 A58538 G2170, G2171
Percutaneous Coronary Intervention
Related terms: heart, angina, intracoronary
L33623 A56823 92920, 92921, 92924, 92925, 92928, 92929, 92933, 92934, 92937, 92938, 92941, 92943, 92944, 92973, 92975, 92978, 92979, 93571, 93572, C9600, C9601, C9602, C9603, C9604, C9605, C9606, C9607, C9608
Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF)
Related terms: compression, spine, fracture
L33569 A56178 A58445 22510, 22511, 22512, 22513, 22514, 22515, 76380
Peripheral Nerve Blocks
Related terms: N/A
L36850 A57452 A55421 64400, 64405, 64415, 64416, 64417, 64418, 64420, 64421, 64425, 64430, 64445, 64446, 64447, 64448, 64449, 64450, 64455, 64454, 64624, 20560, 20561
Platelet Rich Plasma
Related terms: N/A
L38937 A58609 A58693 M0076, P9020, 0232T, 0481T
Posterior Tibial Nerve Stimulation for Voiding Dysfunction
Related terms: overactive bladder, urinary urgency, urinary frequency, urinary incontinence, percutaneous electrical stimulation
L33396 A57453 64566
Prostate Rectal Spacers
Related terms: N/A
L37485 A56539 A58100 55874
Proton Beam Therapy
Related terms: radiation, radiotherapy
L35075 A56827 A55124 77520, 77522, 77523, 77525
Psychiatric Inpatient Hospitalization
Related terms: active treatment
L33624 A56865
Psychiatric Partial Hospitalization Programs
Related terms: mental illness, family counseling, vocational training
L33626 A56850 90785, 90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838, 90846, 90847, 90849, 90853, 90899, 96101, 96102, 96103, 96116, 96118, 96119, 96120, G0129, G0176, G0177, G0410, G0411
Psychiatry and Psychology Services
Related terms: psychiatric, mental illness, Psychotherapy, electroconvulsive therapy, ECT, psychological testing, vocational training, dementia
L33632 A56937 90785, 90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838, 90839, 90840, 90845, 90846, 90847, 90849, 90853, 90863, 90865, 90870, 90880, 90885, 90887, 90889, 90899, 96105, 96112, 96113, 96116, 96121, 96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139, 96146, G0451
RAST Type Tests
Related terms: FAST, Radioallergosorbent, fluoroallergosorbent, antigen, allergen, IGE
L33591 A56844 86001, 86003, 86005, 86008
Reduction Mammaplasty
Related terms: breast reconstruction, cosmetic surgery
L35001 A56837 19316, 19318
Routine Foot Care and Debridement of Nails
Related terms: feet, toes, toenails, corns, calluses, trimming of nails, systemic disease
L33636 A57759 11055, 11056, 11057, 11719, 11720, 11721, G0127
Salvage High-intensity Focused Ultrasound (HIFU) Treatment in Prostate Cancer (PCa)
Related terms: N/A
L38262 A56702 A57835 55899, C9747
Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
Related terms: OCT, eyes, cornea, glaucoma
L34380 A56537 92132, 92133, 92134
Select Minimally Invasive GERD Procedures
Related terms: N/A
L35080 A56863 A58614 43210, 43257, 43284, 43499, 43999, 49999
Speech-Language Pathology
Related terms: dysphagia, swallowing, communication
L33580 A52866 31579, 92507, 92508, 92521, 92522, 92523, 92524, 92597, 92607, 92608, 92609, 92626, 92627, 96105, 96110, 96112, 96113, 97129, 97130, 97533, G0451
Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)
Related terms: ionizing, stereotactic guidance, robotic
L35076 A56874 77371, 77372, 77373, 77432, 77435, G0339, G0340
Total Joint Arthroplasty
Related terms: Knee, TKA, Hip, THA
L36039 A57428 27130, 27132, 27134, 27137, 27138, 27445, 27447, 27486, 27487
Transcranial Magnetic Stimulation
Related terms: depression, major depressive disorder, magnetic field
L33398 A57528 A58145 90867, 90868, 90869
Transesophageal Echocardiography (TEE)
Related terms: ultrasound, esophagus, doppler, color flow, contrast, heart
L33579 A52868 76376, 76377, 93312, 93313, 93314, 93315, 93316, 93317, 93318, 93320, 93321, 93325, C8925, C8926, C8927
Transrectal Ultrasound
Related terms: prostate, ultrasound, echography
L33578 A57427 76872, 76873
Transthoracic Echocardiography (TTE)
Related terms: cardiac, doppler, stress, cardovascular, myocardial, heart, contrast
L33577 A56781 76376, 76377, 93303, 93304, 93306, 93307, 93308, 93320, 93321, 93325, 93350, 93351, 93352, A9700, C8921, C8922, C8923, C8924, C8928, C8929, C8930, J0153, J0280, J0461, J1245, J1250, J2785, Q9955, Q9956, Q9957
Transvenous Phrenic Nerve Stimulation in the Treatment of Central Sleep Apnea
Related terms: N/A
L37929 A57548 A56267 0424T, 0425T, 0426T, 0427T, 0428T, 0429T, 0430T, 0431T, 0432T, 0433T, 0434T, 0435T, 0436T, C1787, C1823
Urine Drug Testing
Related terms: UDT, substance use disorder, SUD, chronic opioid therapy, COT
L36037 A56761 80305, 80306, 80307, G0480, G0481, G0482, G0483
Urodynamics
Related terms: cystometrogram, uroflowmetry, urethral pressure profile, sphincter electromyogram, sphincter electromyogram, incontinence, voiding dysfunction
L33576 A57455 51726, 51727, 51728, 51729, 51736, 51741, 51792, 51797
Varicose Veins of the Lower Extremity, Treatment of
Related terms: telangiectasia, spider veins, cosmetic, ligation and stripping, Endovenous radiofrequency ablation, EFRA, laser ablation
L33575 A52870 A55704 36465, 36466, 36468, 36470, 36471, 36473, 36474, 36475, 36476, 36478, 36479, 36482, 36483, 37700, 37718, 37722, 37735, 37760, 37761, 37765, 37766, 37780, 37799
Venous Angioplasty with or without Stent Placement for the Treatment of Chronic Cerebrospinal Venous Insufficiency
Related terms: CCSVI, multiple sclerosis, MS
L35028 A56845 37248, 37249
Visual Electrophysiology Testing
Related terms: N/A
L36831 A57060 A55475 92273, 92274, 95930, 0509T, 0333T, 0464T
Visual Fields Testing
Related terms: eyes, ophthalmology, vision
L33574 A56551 92081, 92082, 92083
Vitamin D Assay Testing
Related terms: Bone Density, Osteopenia
L37535 A57736 A55852 82306, 82652
Water Vapor Thermal Therapy for LUTS/BPH
Related terms: N/A
L37808 A56590 53854

Medical Policy Articles

Article Title Article # Related CPT/HCPCS Codes
Billing and Coding: Arthroscopic Lavage and Arthroscopic Debridement for the Osteoarthritic Knee – Medical Policy Article
Related Terms: injection
A52369 29877, 29999, G0289
Billing and Coding: Bevacizumab and Biosimilars
Related Terms: drug, retinal
A52370 C9257, J9035, 67028
Billing and Coding: Bortezomib
Related Terms: drug
A52371 J9041, J9044
Billing and Coding: Colorectal Cancer Screening – Medical Policy Article
Related Terms: colonoscopy, sigmoidoscopy, barium enema
A52378 81528, 82270, G0104, G0105, G0106, G0120, G0121, G0122, G0327, G0328
Billing and Coding: Complex Drug Administration Coding
Related Terms: N/A
A58620 96372, 96377, J0517, J0638, J0717, J0896, J0897, J1442, J1447, J2182, J2353, J2357, J2505, J2793, J3245, Q5101, 5108, Q5110, Q5111, Q5120, Q5122, 96365, 96366, 96367, 96368, 96374, 96375, 96376, 96379, J0129, J0222, J0485, J0565, J1300, J1301, J1442, J1602, J2323, J2354, J2786, J3358, J3380, Q5101, Q5110
Billing and Coding: Denosumab (Prolia ™, Xgeva ™)
Related Terms: drug, bone
A52399 J0897, 96372
Billing and Coding: Eculizumab
Related Terms: drug, hemolysis
A54548 J1300
Billing and Coding: Filgrastim, Pegfilgrastim, Tbo-filgrastim and biosimilars
Related Terms: drug, G-CSF
A52408 J1442, J1447, J2505, Q5101, Q5108, Q5110, Q5111, Q5112, J3590
Billing and Coding: Hyaluronans Intra-articular Injections of
Related Terms: drug, knee, ankle
A52420 J7318, J7320, J7321, J7322, J7323, J7324, J7325, J7326, J7327, J7328, J7329, 20610, 20611
Billing and Coding: Ibandronate Sodium
Related Terms: drug, bone, osteoporosis
A52421 J1740
Billing and Coding: Implantable Automatic Defibrillators
Related Terms: N/A
A56326 33202, 33203, 33215, 33216, 33217, 33218, 33220, 33223, 33224, 33225, 33230, 33231, 33240, 33241, 33243, 33244, 33249, 33262, 33263, 33264, 33270, 33271, 33272, 33273, G0448
Billing and Coding: Infliximab and biosimilars
Related Terms: drug
A52423 J1745, Q5103, Q5104
Billing and Coding: Intravenous Immune Globulin (IVIG)
Related Terms: drug, immunodeficiency, ITP
A52446 96365, 96366, C9072, J1459, J1556, J1557, J1561, J1566, J1568, J1569, J1572, J1599
Billing and Coding: IUD (Hormone-Eluting) for Endometrial Hyperplasia - CPT 58999
Related Terms: N/A
A58649 58999
Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs
Related Terms: drug, endometriosis, leuprolide, goserelin
A52453 11981, 11982, 11983, 96402, J1950, J3315, J3316, J9202, J9217, J9218, J9219, J9225
Billing and Coding: Nivolumab
Related Terms: drug
A54862 J9299
Billing and Coding: Omalizumab
Related Terms: drug
A52448 J2357
Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™)
Related Terms: drug
A52450 J9264, J9267
Billing and Coding: Ranibizumab and Aflibercept
Related Terms: eye, ophthalmology, macular
A52451 67028, J0178, J2778, 67916, 67917, 67921, 67922, 67923, 67924, J0179
Billing and Coding: Removal of Benign Skin Lesions
Related Terms: cosmetic
A54602 11200, 11201, 11300, 11301, 11302, 11303, 11305, 11306, 11307, 11308, 11310, 11311, 11312, 11313, 11400, 11401, 11402, 11403, 11404, 11406, 11420, 11421, 11422, 11423, 11424, 11426, 11440, 11441, 11442, 11443, 11444, 11446, 17000, 17003, 17004, 17106, 17107, 17108, 17110, 17111, 17340
Billing and Coding: Rituximab, Rituximab-abbs and Rituximab and hyaluronidase human (Rituxan Hycela™)
Related Terms: drug
A52452 J9311, J9312, Q5115
Billing and Coding: Single Chamber and Dual Chamber Permanent Cardiac Pacemakers
Related Terms: pacemaker
A54909 33206, 33207, 33208
Billing and Coding: Stem Cell Transplantation
Related Terms: marrow, BMT, autologous, allogeneic, bone
A52879 38240, 38241
Blepharoplasty - Medical Policy Article
Related Terms: eye, cosmetic
A52837 15820, 15821, 15822, 15823, 67900, 67901, 67902, 67903, 67904, 67906, 67908, 67909, 67911, 67914, 67915, 67916, 67917, 67921, 67922, 67923, 67924
Chiropractic Services – Medical Policy Article
Related Terms: subluxation, manipulation
A57889 98940, 98941, 98942
Clinical Trials – Medical Policy Article
Related Terms: IDE, Q0, modifier
A52840
Collagen Implantation for Urinary Incontinence - Medical Policy Article
Related Terms: N/A
A52374 51715, L8603, Q3031
CPT Code 87641 (Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, methicillin resistant, amplified probe technique) - Medical Policy Article
Related Terms: staph, MRSA
A52379 87641
Health and Behavior Assessment/Intervention – Medical Policy Article
Related Terms: mental, psychologist
A52434 96156, 96158, 96159, 96164, 96165, 96167, 96168, 96170, 96171
Home Health Skilled Nursing Care: Teaching and Training for Dementia Patients with Behavioral Disturbances - Medical Policy Article
Related Terms: N/A
A52845 G0164
Investigational Device Exemption Requests - Medical Policy Article
Related Terms: IDE, clinical, Q0 modifier
A52841
Laparoscopic Sleeve Gastrectomy (LSG) – Medical Policy Article
Related Terms: morbid, obesity, weight
A52447 43775
Local Coverage Determination (LCD) Reconsideration Process - Medical Policy Article
Related Terms: N/A
A52842
Local Coverage Determination Reconsideration Process - Medical Policy Article
Related Terms: N/A
A52842
New Local Coverage Determination (LCD) Request Process
Related Terms: N/A
A56198
Polysomnography and Sleep Studies – Medical Policy Article
Related Terms: N/A
A53019 95800, 95801, 95805, 95806, 95807, 95808, 95810, 95811, G0398, G0399, G0400
Process for Determining Self-Administered Drug Exclusions – Medical Policy Article
Related Terms: SAD
A53020
Psychological Services Coverage under the Incident to Provision for Physicians and Nonphysicians – Medical Policy Article
Related Terms: psychiatric, mental
A52825 90785, 90832, 90833, 90834, 90836, 90837, 90838, 90846, 90847, 90849, 90853, 90880, 90899
Self-Administered Drug Exclusion List - Medical Policy Article (Jurisdiction 6 Only)
Related Terms: SAD
A53022 C9399, J0129, J0135, J0270, J0364, J0593, J0599, J0630, J0800, J1324, J1438, J1559, J1562, J1595, J1628, J1675, J1744, J1815, J1817, J1830, J2170, J2212, J2354, J2440, J2502, J2760, J2940, J2941, J3030, J3031, J3110, J3355, J3490, J3590, J3357, J7999, J9212, J9213, J9216, J9218, Q0515
Self-Administered Drug Exclusion List - Medical Policy Article (Jurisdiction K Only)
Related Terms: SAD
A53021 C9399, J0129, J0135, J0270, J0364, J0593, J0599, J0630, J0800, J1324, J1438, J1559, J1562, J1595, J1628, J1675, J1744, J1815, J1817, J1830, J2170, J2212, J2354, J2440, J2502, J2760, J2940, J2941, J3030, J3031, J3110, J3355, J3357, J3490, J3590, J7999, J9212, J9213, J9216, J9218, Q0515
Surveillance of Implantable or Wearable Cardioverter Defibrillators (ICDs): Office, Hospital, Web, or Non-Web Based – Medical Policy Article
Related Terms: N/A
A53018 93282, 93283, 93284, 93287, 93289, 93292, 93295, 93296