Medical policy news
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Modified: 2/14/2019
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. This article was revised on February 14, 2019, to reflect the revised CR 10901 issued on February 12, 2019, that includes changes to the updates in Chapter 13 of the Medicare Program Integrity Manual. The CR changed the effective date to October 3, 2018. The CR release date, transmittal number, and the web address of the CR were revised. All other information remains the same. [MM10901]
Modified: 2/13/2019
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.
Modified: 2/7/2019
Based on review, the local coverage determination (LCD) for diagnostic colonoscopy was revised to correct grammatical errors. In addition, the “Sources of Information” section of the LCD was revised to update the sources.
Modified: 2/7/2019
Based on a review of the local coverage determination (LCD) for allergy testing, Current Procedural Terminology (CPT®) code 86005 was removed from the “ICD-10 Codes that DO NOT Support Medical Necessity” section of the LCD as this service is a non-specific screening test that does not identify a specific antigen, and is not covered.
Modified: 2/7/2019
Based on a review of the local coverage determination (LCD) for bone mineral density studies, grammatical errors were identified and corrected.
Modified: 2/7/2019
Based on review of the local coverage determination (LCD) for CYP2C19, CYP2D6, CYP2C9, and VKORC1 genetic testing, formatting errors were corrected throughout the LCD.
Modified: 2/7/2019
Based on a review of the local coverage determination (LCD) for cardiology – non-emergent outpatient testing: exercise stress test, stress echo, MPI SPECT, and cardiac PET, grammatical errors were corrected.
Modified: 2/7/2019
Based on a review of the local coverage determination (LCD) for colorectal cancer screening, grammatical and formatting errors were corrected throughout the LCD.
Modified: 2/7/2019
Based on review of the local coverage determination (LCD) for destruction of paravertebral facet joint nerve(s), grammatical and formatting errors were corrected throughout the LCD.
Modified: 2/7/2019
The local coverage determination (LCD) for duplex scan of lower extremity arteries was revised to add ICD-10-CM diagnosis code ranges S91.001A – S91.001S and S91.002A – S91.002S to the “ICD-10 Codes that Support Medical Necessity” section of the LCD.
Modified: 2/7/2019
Based on a review of the local coverage determination (LCD) for E & M home and domiciliary visits, grammatical and formatting errors were corrected.
Modified: 2/7/2019
Based on a review of the local coverage determination (LCD) for electroretinography, grammatical errors were corrected.
Modified: 2/7/2019
Based on a review of the local coverage determination (LCD) for independent diagnostic testing facility (IDTF), grammatical and formatting errors were corrected.
Modified: 2/7/2019
Based on a review of the local coverage determination (LCD) for magnetic resonance angiography, grammatical errors were corrected throughout the LCD.
Modified: 2/7/2019
Based on review of the local coverage determination (LCD) for nail debridement, grammatical and formatting errors were corrected throughout the LCD.
Modified: 2/7/2019
Based on a review of the local coverage determination (LCD) for omalizumab (Xolair®), grammatical errors were corrected.
Modified: 2/7/2019
Based on review of the local coverage determination (LCD), the "Sources of Information" section was updated to add multiple published sources. The content of the LCD has not been changed.
Modified: 2/7/2019
Based on review of the local coverage determination (LCD) for psychiatric inpatient hospitalization, grammatical and formatting errors were corrected throughout the LCD.
Scanning computerized ophthalmic diagnostic imaging (SCODI) -- revision to the Part A and Part B LCD
Modified: 2/7/2019
Based on a review of the local coverage determination (LCD) for scanning computerized ophthalmic diagnostic imaging (SCODI), grammatical errors were corrected.
Modified: 2/7/2019
Based on a review of the local coverage determination (LCD) for special histochemical stains & immunohistochemical stains, grammatical errors were corrected.
Modified: 2/7/2019
Based on review of the local coverage determination (LCD) and related “Coding Guidelines” article for spinal cord stimulation for chronic pain, grammatical errors were identified and corrected.
Modified: 2/7/2019
Based on a review of the local coverage determination (LCD) for transcranial magnetic stimulation for major depressive disorder, grammatical errors were corrected and the “Sources of Information” section of the LCD was revised to alphabetize the references.
Modified: 2/7/2019
Based on review of the local coverage determination (LCD) for treatment of varicose veins of the lower extremity, grammatical errors were corrected.
Modified: 2/7/2019
Based on review of the local coverage determination (LCD) for vestibular function tests, grammatical errors were corrected.
Modified: 2/7/2019
Based on change request (CR) 10901, the local coverage determination (LCD) for viscosupplementation therapy for the knee was revised to update the “CMS National Coverage Policy” section of the LCD for Pub. 100-08, Chapter 13 from Section 5.1 to Section 13.5.4.
Modified: 2/7/2019
Based on a review of the local coverage determination (LCD) for vitamin B12 injections, the registered trademark was added to the drug name “Alimta®” and outdated Centers for Medicare & Medicaid Services (CMS) sources were removed from the LCD.
Modified: 2/7/2019
Based on a review of the local coverage determination (LCD) for wireless capsule endoscopy, grammatical errors were corrected.
Modified: 2/2/2019
This calculator will assist you in determining when additional documentation requested by First Coast Service Options Inc. (First Coast) must be received.
Modified: 1/31/2019
Link to the CMS Medicare Coverage Database. The following results include only documents currently in effect.
Modified: 1/31/2019
New Part A and Part B LCD for noncovered service - 4kscore test algorithm.
Modified: 1/24/2019
Based on review of the local coverage determination (LCD), typographical errors were corrected, and outdated sources were removed from the "Sources of Information and Basis for Decision" section of the LCD.
Modified: 1/24/2019
Based on review of the local coverage determination (LCD), some of the italicized language did not represent direct quotations from the CMS sources listed, and was revised to assure consistency with the CMS sources.
Modified: 1/24/2019
Based on review of the local coverage determination (LCD), language was removed from the Limitations of Coverage” section of the LCD.
Modified: 1/17/2019
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: 1/17/2019
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: 1/15/2019
Link to the CMS Medicare Coverage Database. The following results include only documents currently in effect.
Modified: 1/15/2019
Link to the CMS Medicare Coverage Database. The following results include only documents currently in effect.
Modified: 1/10/2019
Listing of local coverage determinations (LCDs) impacted by the 2019 Healthcare Common Procedure Coding System (HCPCS) annual update.
Modified: 1/7/2019
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.
Modified: 1/4/2019
As of January 4, 2019, the PDF format of First Coast’s LCDs is no longer available on medicare.fcso.com. Providers can still search for LCDs by ID, keyword, or HCPCS on the website.
Modified: 1/4/2019
New Part A and Part B LCD L37564 Frequency of Hemodialysis.
Modified: 1/4/2019
Based on change request (CR) 11043, the local coverage determination (LCD) “coding guideline” attachment for independent diagnostic testing facility (IDTF) was revised.
Modified: 12/26/2018
Link to the CMS Medicare Coverage Database. The following results include only documents currently in effect.
Modified: 10/18/2018
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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