Change request 10901 updates the "Medicare Program Integrity Manual" with detailed changes to the local coverage determination (LCD) process, which will help to increase transparency, clarity, consistency, reduce provider burden, and enhance public relations while retaining the ability to be responsive to local clinical and coverage policy concerns. [MM10901]
So coding changes can be made more efficiently without requiring reconsideration of an LCD, CPT® and ICD-10 codes are being relocated from LCDs to associated billing and coding articles or policy articles. [CR10901]
Based on change request (CR) 10901, the local coverage determination for polysomnography and sleep testing, was revised to remove all current procedural terminology (CPT®) and ICD-10–CM diagnosis codes and place them into a newly created billing and coding article.
Based on change request (CR) 10901, the local coverage determination for iridotomy by laser surgery was revised to remove all current procedural terminology (CPT®) and ICD-10–CM diagnosis codes and place them into a newly created billing and coding article.
Based on change request (CR) 10901, the local coverage determination for laser trabeculoplasty was revised to remove all current procedural terminology (CPT®) and ICD-10–CM diagnosis codes and place them into a newly created billing and coding article.
Based on change request (CR) 10901, the local coverage determination for laser treatment for psoriasis was revised to remove all current procedural terminology (CPT®) and ICD-10–CM diagnosis codes and place them into a newly created billing and coding article.
Based on change request (CR) 10901, the local coverage determination for ophthalmological diagnostic services was revised to remove all current procedural terminology (CPT®) and ICD-10–CM diagnosis codes and place them into a newly created billing and coding article.
Based on change request (CR) 10901, the local coverage determination for ophthalmoscopy, was revised to remove all current procedural terminology (CPT®) and ICD-10–CM diagnosis codes and place them into a newly created billing and coding article.
Based on change request (CR) 10901, the local coverage determination for transcranial doppler studies was revised to remove all current procedural terminology (CPT®) and ICD-10–CM diagnosis codes and place them into a newly created billing and coding article.
Based on change requests (CRs)11322 and 11333 (Annual [2020] ICD-10-CM Update), the billing and coding article for single chamber and dual chamber permanent cardiac pacemakers was revised.
Based on change request (CR) 10901, the local coverage determination for BRCA1 and BRCA2 genetic testing was revised to remove all current procedural terminology (CPT®) and ICD-10–CM diagnosis codes and place them into a newly created billing and coding article.
Based on change request (CR) 10901, the local coverage determination for genetic testing for lynch syndrome was revised to remove all current procedural terminology (CPT®) and ICD-10–CM diagnosis codes and place them into a newly created billing and coding article.
Based on change request (CR) 11333 (Annual [2020] ICD-10-CM Update), the billing and coding article for implantable automatic defibrillators was revised.
Based on change request (CR) 10901, the local coverage determination for molecular pathology procedures was revised to remove all current procedural terminology (CPT®) and ICD-10–CM diagnosis codes and place them into a newly created billing and coding article.
Based on multiple change requests (CRs) for the October 2019 Quarterly Updates, the ”Sources of Information” section of the local coverage determination (LCD) for trastuzumab – trastuzumab biologics was updated to include the U.S. Food and Drug Administration (FDA) label for KANJINTI™(trastuzumab-anns) and TRAZIMERA™ (trastuzumab-qyyp).
Based on multiple change requests (CRs) for the October 2019 Quarterly Updates, the ”Sources of Information” section of the local coverage determination (LCD) for vascular endothelial growth factor inhibitors for the treatment of ophthalmological diseases was updated to include the U.S. Food and Drug Administration (FDA) label for Zirabev™.
Based on change request (CR) 10901, the local coverage determination for viscosupplementation therapy for knee was revised to remove all current procedural terminology (CPT®) and ICD-10–CM diagnosis codes and place them into a newly created billing and coding article.
This calculator will assist you in determining when additional documentation requested by First Coast Service Options Inc. (First Coast) must be received.
The Centers for Medicare & Medicaid Services (CMS) requires that any Medicare service provided or ordered must be authenticated by the author -- the one who provided or ordered that service. This article outlines acceptable forms of authentication.
When a medical reviewer contacts the provider requesting to submit an attestation statement or signature log to authenticate a medical record, the provider must submit the attestation statement or signature log within the following 20 calendar days. [CR 6698]
Based on change request (CR) 10901, the local coverage determination for upper eyelid and brow surgical procedures was revised to remove all current procedural terminology (CPT®) and ICD-10–CM diagnosis codes and place them into a newly created billing and coding article.
Based on change request (CR) 10901, the local coverage determination for ultrasound, soft tissues of head and neck, was revised to remove all current procedural terminology (CPT®) and ICD-10–CM diagnosis codes and place them into a newly created billing and coding article.
Based on change request (CR) 11392, the billing and coding article for bone mineral density studies was revised to add Current Procedural Terminology (CPT®) codes to the CPT®/HCPCS Codes Group 2 section of the billing and coding article.
Based on change request (CR) 11392 (ICD-10 and Other Coding Revisions to National Coverage Determinations [NCDs]-January 2020 Update), the independent diagnostic testing facility “Coding Guidelines” attachment was revised.
Based on change request (CR) 10901, the local coverage determination for stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) was revised to remove all current procedural terminology (CPT®) and ICD-10–CM diagnosis codes and place them into a newly created billing and coding article.
Payment will be considered for unused and discarded portions of a single-use drug/biological product. The JW modifier is not permitted when the actual dose of the drug or biological administered is less than the billing unit.
Please review this article from the durable medical equipment Medicare administrative contractors (DME MACs) about ordering lower limb orthoses (LLO) for your Medicare patients.
Please review this article from the durable medical equipment Medicare administrative contractors (DME MACs) about ordering spinal orthoses for your Medicare patients.
First Coast has implemented a new process to reduce provider burden and process claims more efficiently. If you submit claims for skin substitutes or radiopharmaceutical codes, learn how this new process will benefit you.
Based on a local coverage determination challenge for noncovered services (LCD), the LCD was revised to remove hypoglossal nerve stimulator Current Procedural Terminology (CPT®) codes.
Please review these quick tips from the durable medical equipment Medicare administrative contractor (DME MAC) about ordering oxygen and oxygen equipment for your Medicare patients.
Link to the CMS Medicare Coverage Database. The following results include only documents currently in effect.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.
