Medical policy news
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Modified: 10/18/2018
The local coverage determination (LCD) and related “Coding Guidelines” for allergen immunotherapy are being retired based on the development of the new LCD and “Coding Guidelines” for allergen immunotherapy (L37800).
Modified: 10/18/2018
The LCD was revised to add the new FDA approved indications for Granix and to update the "Sources of Information" section of the LCD. Also, based on change request (CR) 10834, the LCD was revised to add HCPCS code Q5110 (NIVESTYM™ [filgrastim-aafi] to the CPT/HCPCS Codes section, and the FDA approved indications for NIVESTYM™ (filgrastim-aafi) were added to the Coverage Indications, Limitations, and/or Medical Necessity section of the LCD.
Modified: 10/18/2018
The LCD was revised to add Healthcare Common Procedure Coding System (HCPCS) code C9750 to the CPT/HCPCS Codes Group 1 under the "Procedures for Part A and Part B" section of the LCD, and CPT Code 33999+ was moved from CPT/HCPCS Codes Group 4 to CPT/HCPCS Group 5 Procedures for Part B only section of the LCD.
Modified: 10/11/2018
List of LCDs impacted by the 2019 update to the ICD-10-CM diagnosis coding structure is effective for services rendered on or after October 1, 2018.
Modified: 10/11/2018
The LCD was revised to change diagnosis code T36.4X5A to diagnosis code range T36.4X5A-T36.4X5S, diagnosis code T45.515A to diagnosis code range T45.515A-T45.515S, and diagnosis code T50.B95A to diagnosis code range T50.B95A-T50.B95S, as they were omitted in error.
Modified: 10/11/2018
The LCD was revised remove ICD-10-CM diagnosis code D64.9 from the “ICD-10 Codes that Support Medical Necessity” “Group 3 Codes:” section of the LCD for HCPCS codes J0885 and Q5106, as it is on the list of national non-covered diagnoses.
Modified: 10/11/2018
The LCD was revised to remove diagnoses codes that were included in the ICD-10 Codes that Support Medical Necessity/Group 2 Codes/Total Knee Arthroplasty section of the LCD in error.
Modified: 10/11/2018
The LCD was revised to add HCPCS code Q5108 to the CPT/HCPCS Codes section of the LCD.
Modified: 10/4/2018
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]
Modified: 9/28/2018
Link to the CMS Medicare Coverage Database. The following results include only documents currently in effect.
Modified: 9/27/2018
The LCD was revised to change diagnoses code range S85.001A-S85.999S to diagnoses code ranges S85-001A-S85.299S and S85.801A-S85.999S, and to add language omitted in error under the Coverage Indications, Limitations and/or Medical Necessity section of the LCD.
Modified: 9/19/2018
The LCD was revised under the heading "The Destination" to add "site of transfer (e.g. airport or helicopter pad) between modes of ambulance transport" as a covered destination for emergency ambulance services.
Modified: 9/13/2018
The LCD was revised to update the CMS National Coverage Policy section manual references, and the ICD-10 codes that support medical necessity for each group of ICD-10-CM diagnoses codes was updated.
Modified: 9/6/2018
The LCD was revised to add language to reflect changes recently enacted into law by the 21st Century Cures Act.
Modified: 8/30/2018
New Part B LCD L37800 Allergen Immunotherapy.
Modified: 8/5/2018
This calculator will assist you in determining when additional documentation requested by First Coast Service Options Inc. (First Coast) must be received.
Modified: 8/2/2018
Link to the CMS Medicare Coverage Database. The following results include only documents currently in effect.
Modified: 7/31/2018
Link to the CMS Medicare Coverage Database. The following results include only documents currently in effect.
Modified: 7/31/2018
Link to the CMS Medicare Coverage Database. The following results include only documents currently in effect.
Modified: 7/19/2018
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.
Modified: 7/19/2018
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]
Modified: 5/4/2018
Link to the CMS Medicare Coverage Database. The following results include only documents currently in effect.
Modified: 8/18/2017
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.
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