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LCD and Billing and Coding Article Updates – 2025

January

Psychiatric Partial Hospitalization Programs L33626

Effective 1/1/2024, in the Coverage Indications, Limitations and/or Medical Necessity section, the third list under Limitations has been updated to align with CMS guidelines, based on CFR 424.24.

March/April

Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound (A58893)

Effective 4/1/2025: Based on the quarterly HCPCS update, Q4231 has been deleted and replaced with A2035.

Effective 10/1/2024: Due to the annual ICD-10-CM update, codes M51.36, M51.37, M65.9 were deleted from Group 1. New codes M51.360, M51.361, M51.362, M51.369, M51.370, M51.371, M51.372, M51.379, M62.85, M65.90, M65.911, M65.912, M65.919, M65.921, M65.922, M65.929, M65.931, M65.932, M65.939, M65.941, M65.942, M65.949, M65.951, M65.952, M65.959, M65.961, M65.962, M65.969, M65.971, M65.972, M65.979, M65.98, M65.99 have been added.

Billing and Coding: Eculizumab, and Biosimilars: EPYSQLI®-eculizumab-aagh, and BKEMV™-eculizumab-aeeb (A54548)

Based on the quarterly HCPCS update, the following revisions have been made:

HCPCS code J1300 has been deleted and replaced by HCPCS codes J1299, effective 4/1/2025.

HCPCS code Q5139 has been deleted and replaced by HCPCS codes Q5152, and should be used to report eculizumab-aeeb, effective 4/1/2025.

HCPCS code Q5151 has been added and should be used to report eculixumab-aagh, effective 4/1/2025.

Billing and Coding: Epidural Steroid Injections for Pain Management (A58745)

Under Article Text subheading Coding Guidance added the sentence “Do not use epidural CPT® codes to bill chemotherapy/complex drug administration", effective for services rendered on or after 12/05/2021.

Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM) (A58116)

Effective 04/01/2025, in the quarterly HCPCS/CPT Updates, HCPCS codes G0564 and G0565 are being removed from Group 1. Verbiage has been updated in the article for this change.

Billing and Coding: Ranibizumab and biosimilars, Aflibercept, Aflibercept HD, Brolucizumab-dbll, Faricimab-svoa, and PAVBLU™aflibercept-ayyh, AHZANTIVE®aflibercept-abzv. and ENZEEVU™aflibercept-mrbb (A52451)

Based on the HCPCS quarterly update, the following wording was added to the Article Text:

  • PAVBLU™ (aflibercept-ayyh) is a vascular endothelial growth factor (VEGF) inhibitor used as an intravitreal injection.
  • AHZANTIVE®(aflibercept-abzv) is a vascular endothelial growth factor (VEGF) inhibitor used as an intravitreal injection.
  • ENZEEVU™ (aflibercept-mrbb) is a vascular endothelial growth factor (VEGF) inhibitor used as an intravitreal injection.
  • Effective 4/1/2025, PAVBLU™ (aflibercept-ayyh) should be reported using HCPCS code Q5147.
  • Effective 4/1/2025, AHZANTIVE® (aflibercept-mrbb) should be reported using HCPCS code Q5150.
  • Effective 4/1/2025, ENZEEVU™ (aflibercept-abzv) should be reported using HCPCS code Q5149.
    • Based on the HCPCS quarterly update, the following HCPCS codes were added to the CPT/HCPCS Code section: Q5147, Q5150, and Q5149, effective for services on or after 4/1/2025.
    • PAVBLU™ (aflibercept-ayyh), AHZANTIVE®(aflibercept-mrbb), and ENZEEVU™(aflibercept-abzv) were added to the "ICD-10-CM Codes that Support Medical Necessity" -Group 2 Paragraph

Billing and Coding: Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms (A56867)

Consolidated all “ICD-10-CM Codes that Support Medical Necessity” sections into a single Group 1 that supports medical necessity for all CPT/HCPCS Codes listed in the CPT/HCPCS- Group 1, effective for services rendered on or after 1/1/2025.

May

Billing and Coding: IUD (Hormone-Eluting) for Endometrial Hyperplasia - CPT 58999 (A58649)

Added ICD-10-CM diagnosis code N85.02 to the "ICD-10-CM Codes that Support Medical Necessity" section, Group 1, effective for services rendered on or after 4/1/2025.

Posted 6/24/2025

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