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]
The local coverage determination (LCDs) for sacral neuromodulation was revised to remove all billing and coding, and place them into billing and coding articles related to the LCDs.
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.
The local coverage determination (LCD) for bone mineral density studies was revised to remove all billing and coding and place them into a billing and coding article.
The local coverage determinations (LCDs) for diagnostic colonoscopy and colorectal cancer screening were revised to remove all billing and coding, and place them into billing and coding articles related to the LCDs.
The local coverage determination (LCD) for hemophilia clotting factors was revised to remove all billing and coding and place them into a newly created billing and coding article.
The independent diagnostic testing facility (IDTF) local coverage determination (LCD) “coding guidelines” attachment was revised to include Current Procedural Terminology (CPT®) code 0508T.
Based on change request (CR) 11005, the screening and diagnostic mammography local coverage determination (LCD) was updated to add ICD-10-CM diagnoses to the "ICD-10 Codes that Support Medical Necessity" section of the LCD.
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.
The local coverage determination (LCD) for intravenous immune globulin was revised to update the “Coverage Indications, Limitations, and/or Medical Necessity” and “Utilization Guidelines” sections of the LCD to include the Food and Drug Administration (FDA) and off label dosage recommendation indications.
Based on change request (CR) 10951, revisions were made to Part B LCDs named in the article to update the internet only manual (IOM) citations in the “Centers for Medicare & Medicaid Services (CMS) National Coverage Policy” section of the LCDS to be consistent with the IOM publications.
Based on change request (CR) 10951, multiple Part A and Part B local coverage determinations (LCDs) were revised to update the internet only manual (I0M) citations in the “Centers for Medicare & Medicaid Services (CMS) National Coverage Policy” section of the LCDs to be consistent with the CMS IOM publications.
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.
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]
Link to the CMS Medicare Coverage Database. The following results include only documents currently in effect.
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