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Medical policy news

LCD search tools

The LCD search tools offer a fast, direct way for providers to search for LCDs.
Modified: 4/1/2020
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: 2/6/2020
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]
Modified: 4/9/2020
Multiple Part A and Part B LCDs and related billing and coding articles are being retired.
Modified: 4/9/2020
Revisions have been made to the billing and coding article A57531 for allergy testing.
Modified: 4/9/2020
Part A and Part B LCD and related billing and coding article are being retired.
Modified: 4/9/2020
Revisions have been made to the billing and coding article A57451 for molecular pathology procedures.
Modified: 4/9/2020
Revisions have been made to the billing and coding article A57725 for pegfilgrastim.
Modified: 4/9/2020
Part A and Part B LCD and related billing and coding article are being retired.
Modified: 4/9/2020
Revisions have been made to the billing and coding article A57182 for transthoracic echocardiography (TTE).
Modified: 4/2/2020
Multiple Part B LCDs and related billing and coding articles are being retired.
Modified: 4/2/2020
Revisions have been made to the billing and coding article A56484 for bone mineral density studies.
Modified: 4/1/2020
Online registration is canceled for the April 7 contractor advisory committee (CAC) meeting.
Modified: 4/1/2020
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: 3/31/2020
The decision has been made to cancel the April 7, 2020, CAC meeting and the online registration has been closed.
Modified: 3/25/2020
Please review this article from the durable medical equipment Medicare administrative contractors (DME MACs) about ordering spinal orthoses for your Medicare patients.
Modified: 3/19/2020
Revisions have been made to the Self-administered drug (SAD) list to add Tremfya® (guselkumab) (J1628) and Stelara® (ustekinumab) subcutaneous (J3357).
Modified: 3/19/2020
Based on a review, this billing and coding article was revised to add the new Food and Drug Administration (FDA) approved drug Panzyga® (immune globulin intravenous, human – IFAS).
Modified: 3/16/2020
Based on a reconsideration request, the billing and coding article was revised to add ICD-10-CM diagnoses codes to the ICD-10 Codes that Support Medical Necessity/Group 4 Codes.
Modified: 3/12/2020
Retirement of multiple Part B LCDs and related billing and coding articles.
Modified: 3/12/2020
Based on review of the billing and coding article for controlled substance monitoring and drugs of abuse testing billing, the article was revised to remove Current Procedural Terminology (CPT®) code 83789 as it is not a test for drugs.
Modified: 3/10/2020
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: 3/5/2020
Based on the Food and Drug Administration (FDA) approval of Enhertu (fam-trastuzumab deruxtecan- nxki), the billing and coding article was revised to add HCPCS code C9399.
Modified: 3/5/2020
The local coverage determination (LCD) and the billing and coding article for pegfilgrastim was revised to add the new Food and Drug Administration (FDA) approved biosimilar drug pegfilgrastim-bmez.
Modified: 3/5/2020
Based on review of the peripheral nerve blocks billing and coding article, it was determined that Current Procedural Terminology (CPT®) code 64451 was added in error, therefore, it is being removed from the billing and coding article.
Modified: 3/5/2020
Based on the 2020 Healthcare Common Procedure Coding System (HCPCS) update, the billing and coding article was revised to add CPT code 64451.
Modified: 3/5/2020
Revisions to the stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) local coverage determination and the billing and coding article.
Modified: 2/27/2020
The billing and coding article for major joint replacement (hip and knee) was revised to add ICD-10-CM diagnosis codes to the ICD-10 Codes that Support Medical Necessity/Group 1 Codes.
Modified: 2/26/2020
Please review this article from the durable medical equipment Medicare administrative contractors (DME MACs) about ordering surgical dressings for your Medicare patients.
Modified: 2/24/2020
Link to the CMS Medicare Coverage Database. The following results include only documents currently in effect.
Modified: 2/20/2020
Based on further review of the BRCA1 and BRCA2 genetic testing billing and coding article, the “CPT®/HCPCS Codes/Group 1 Codes:” section of the billing and coding article was revised.
Modified: 2/20/2020
Based on review of the local coverage determination (LCD) and Billing and Coding Article, it was determined that the LCD and Billing and Coding Article were no longer required and, therefore, are being retired.
Modified: 2/20/2020
Based on review of multiple local coverage determinations (LCDs) and billing and coding articles, it was determined that they are no longer required and therefore, are being retired.
Modified: 2/20/2020
The noncovered services billing and coding article for noncovered services was revised to remove Current Procedural Terminology (CPT®) codes for vaccines as they have no preventive benefit.
Modified: 2/20/2020
The billing and coding article was revised to add CPT codes to the "Group 2 Codes" section.
Modified: 1/31/2020
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: 1/27/2020
Please review this article from the DME MACs about ordering PAP devices and related accessories for your Medicare patients.
Modified: 1/22/2020
A revised Provider Compliance Tips for Polysomnography (Sleep Studies) fact sheet is available. Learn about coverage requirements, documentation, and how to prevent claim denials.
Modified: 12/9/2019
Please review this article from the durable medical equipment Medicare administrative contractors (DME MACs) about ordering lower limb orthoses (LLO) for your Medicare patients.
Modified: 11/28/2019
Link to the CMS Medicare Coverage Database. The following results include only documents currently in effect.
Modified: 10/22/2019
Link to the CMS Medicare Coverage Database. The following results include only documents currently in effect.
Modified: 10/16/2019
Link to the CMS Medicare Coverage Database. The following results include only documents currently in effect.
Modified: 10/16/2019
Link to the CMS Medicare Coverage Database. The following results include only documents currently in effect.
Modified: 10/5/2019
This calculator will assist you in determining when additional documentation requested by First Coast Service Options Inc. (First Coast) must be received.
Modified: 9/26/2019
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: 9/21/2019
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.
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.