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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: 9/25/2019
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. [MM10901]
Modified: 11/9/2019
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: 11/14/2019
This new local coverage determination (LCD) addresses "Coverage Indications, Limitations, and/or Medical Necessity," "Place of Service," and "Provider Qualifications" requirements for endovenous stenting.
Modified: 11/14/2019
This new local coverage determination (LCD) addresses "Coverage Indications, Limitations, and/or Medical Necessity," "Place of Service," and "Provider Qualifications" requirements for gastrointestinal pathogen (GIP) panels utilizing multiplex nucleic acid amplification techniques (NAATs).
Modified: 11/14/2019
This new local coverage determination (LCD) addresses "Coverage Indications, Limitations, and/or Medical Necessity," "Place of Service," and "Provider Qualifications" requirements for micro-invasive glaucoma surgery (MIGS).
Modified: 11/14/2019
Based on review of the local coverage determination (LCD) for psychiatric partial hospitalization program, the LCD will be retired.
Modified: 10/31/2019
Based on review of the local coverage determination (LCD) for azacitidine (Vidaza®), the LCD will be retired.
Modified: 10/31/2019
Based on review of the local coverage determination (LCD) for bendamustine hydrochloride, the LCD will be retired.
Modified: 10/31/2019
Based on change request (CR) 10901, the local coverage determination for erythropoiesis stimulating agents (ESA) 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.
Modified: 10/31/2019
Based on review of the local coverage determination (LCD) for gemcitabine (Gemzar®), the LCD will be retired.
Modified: 10/24/2019
Based on change request (CR) 10901, the local coverage determination for bisphosphonates (intravenous [IV]) and monoclonal antibodies in the treatment of osteoporosis and their other indications 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.
Modified: 10/24/2019
Based on change request (CR) 10901, the local coverage determination for allergy 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.
Modified: 10/24/2019
Based on change request (CR) 10901, the local coverage determination for surgical decompression for peripheral polyneuropathy 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.
Modified: 10/24/2019
Based on change request (CR) 10901, the local coverage determination for syphilis test 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.
Modified: 10/24/2019
Based on change request (CR) 10901, the local coverage determination for psychiatric diagnostic evaluation and psychotherapy 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.
Modified: 10/24/2019
Based on change request (CR) 10901, the local coverage determination for sinus x-ray(s) 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.
Modified: 10/17/2019
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.
Modified: 10/17/2019
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.
Modified: 10/17/2019
The Self-administered drug (SAD) list has been revised to add drugs that are usually self-administered, and therefore not covered by Medicare.
Modified: 10/10/2019
The 2020 ICD-10-CM diagnoses coding structure (Change Requests (CRs) 11322 and 11333 is effective for services rendered on or after October 1, 2019.
Modified: 10/10/2019
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.
Modified: 10/10/2019
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.
Modified: 10/10/2019
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.
Modified: 10/10/2019
Based on change request (CR) 11333 (Annual [2020] ICD-10-CM Update), the billing and coding article for implantable automatic defibrillators was revised.
Modified: 10/10/2019
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.
Modified: 10/10/2019
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).
Modified: 10/10/2019
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™.
Modified: 10/10/2019
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.
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: 10/3/2019
The local coverage article, Billing and Coding for Frequency of Hemodialysis was revised to clarify some of the verbiage in the article text.
Modified: 9/30/2019
Link to the CMS Medicare Coverage Database. The following results include only documents currently in effect.
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: 9/26/2019
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: 9/26/2019
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.
Modified: 9/26/2019
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.
Modified: 9/26/2019
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.
Modified: 9/26/2019
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.
Modified: 9/13/2019
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.
Part A