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]
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]
Based on change request (CR) 10901, the local coverage determination for trastuzumab 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.
Based on change request (CR) 10901, the local coverage determination for frequency of hemodialysis 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.
Based on change request (CR) 10901, the local coverage determination (LCD) for bendamustine hydrochloride (Treanda®, Bendeka™) was revised to remove all billing and coding and all language not related to reasonable and necessary provisions and place them into a newly created billing and coding article.
Based on change requests (CRs) 11293, 11296, 11298, 11318, and 11328, the billing and coding article for hemophilia clotting factors was updated to remove Healthcare Common Procedure Coding System (HCPCS) codes C9141 and J7199 were removed and replaced with HCPCS code J7208.
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 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]
The new local coverage determination (LCD) for anorectal manometry and electromyography (EMG) of the urinary and anal sphincters was developed to address coverage criteria, coding requirements, documentation requirements, and utilization parameters for anorectal manometry and electromyography.
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.
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.