Please note: We have become aware that the CPT/HCPCS codes may not be appearing on the articles below. We are working to resolve the issue.
The following articles have been revised to reflect the 2025 annual CPT/HCPCS code updates effective for dates of service on and after January 1, 2025:
The following article has been revised and will become effective March 16, 2025:
The following billing and coding article has also been revised:
The following LCD, which was posted for comment on July 27, 2023, has been posted for notice. The LCD and related billing and coding article will become effective February 23, 2025.
The following response to comments article contains summaries of all comments received and Novitas’ responses.
The following LCD has been revised.
The Novitas medical policy team has evaluated all active articles for any impact in response to the 2025 annual HCPCS/CPT code update. The following is a list of the impacted articles. The revised articles will be published to the Medicare Coverage Database and on our website later this month. Please continue to watch our website for updates.
Billing and Coding: Allergy Testing (A56558)
Billing and Coding: Ambulatory Electrocardiograph (AECG) Monitoring (A59268)
Billing and Coding: Biomarkers for Oncology (A52986)
Billing and Coding: Blepharoplasty, Blepharoptosis Repair and Surgical Procedures of the Brow (A57618)
Billing and Coding: BRCA1 and BRCA2 Genetic Testing (A56542)
Billing and Coding: Cardiac Rhythm Device Evaluation (A56602)
Billing and Coding: Cosmetic and Reconstructive Surgery (A56587)
Billing and Coding: Endovascular Repair of Aortic and/or Iliac Aneurysms (A53124)
Billing and Coding: Genetic Testing for Cardiovascular Disease (A58795)
Billing and Coding: Immune Globulin (A56786)
Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM) (A58110)
Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A53252)
Billing and Coding: Magnetic Resonance Angiography (MRA) (A56805)
Billing and Coding: Magnetic-Resonance-Guided Focused Ultrasound Surgery (MRgFUS) for Essential Tremor (A57839)
Billing and Coding: Molecular Pathology and Genetic Testing (A58917)
Billing and Coding: Multiple Imaging in Oncology (A56848)
Billing and Coding: Nerve Conduction Studies and Electromyography (A54095)
Billing and Coding: Non-Invasive Cerebrovascular Arterial Studies (A52992)
Billing and Coding: Pharmacogenomics Testing (A58801)
Billing and Coding: Psychiatric Codes (A57130)
Billing and Coding: Removal of Benign Skin Lesions (A57113)
Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (A57600)
Billing and Coding: Speech-Language Pathology (SLP) Services: Communication Disorders (A54111)
Billing and Coding: Transesophageal Echocardiography (TEE) (A56505)
Billing and Coding: Treatment of Chronic Venous Insufficiency of the Lower Extremities (A55229)
Billing and Coding: Vestibular and Audiologic Function Studies (A57434)
Billing and Coding: Wound Care (A53001)
Self-Administered Drug Exclusion List (A53127)
The following LCDs and related billing and coding articles have been retired:
Blood Glucose Monitoring in a Skilled Nursing Facility (SNF) (L34834)
Billing and Coding: Blood Glucose Monitoring in a Skilled Nursing Facility (SNF) (A56591)
Intensity Modulated Radiation Therapy (IMRT) (L36711)
Billing and Coding: Intensity Modulated Radiation Therapy (IMRT) (A56725)
The following LCD which was posted for notice on October 17 became effective on December 1. The related billing and coding article for this LCD is also now effective:
Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound (L39879)
Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound (A59766)
The comment period is now closed for the proposed LCD listed below. Comments received will be reviewed by our Contractor Medical Directors. The response to comments article will be posted to our website when the final LCD is posted for notice.
Botulinum Toxins (DL38809)
The following article has been revised and will become effective December 1:
Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound (A59766)
The following LCD, which was posted for comment on April 25, has been posted for notice. The LCD and related billing and coding article will become effective February 12, 2025.
The following response to comments article contains summaries of all comments received and Novitas’ responses.
As a reminder, the comment period for the following proposed LCD is currently open and will close on November 23. Please consider including literature/evidence in support of your request with your comments. We encourage you to submit your comments as soon as possible.
Botulinum Toxins (DL38809)
Submit Comments
The following billing and coding articles have been revised.
Billing and Coding: Cervical Fusion (A59668)
Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A53252)
The following article has been revised:
Self-Administered Drug Exclusion List (A53127)
The following billing and coding articles have been revised to reflect the Annual ICD-10-CM code updates effective for dates of service on and after October 1:
Billing and Coding: Allergy Testing (A56558)
Billing and Coding: Bariatric Surgical Management of Morbid Obesity (A56422)
Billing and Coding: Biomarkers for Oncology (A52986)
Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing (A56645)
Billing and Coding: Cosmetic and Reconstructive Surgery (A56587)
Billing and Coding: Diagnostic Colonoscopy (A58428)
Billing and Coding: Electroretinography (ERG) (A56672)
Billing and Coding: Intensity Modulated Radiation Therapy (IMRT) (A56725)
Billing and Coding: Intraoperative Neurophysiological Testing (A56722)
Billing and Coding: Magnetic Resonance Angiography (MRA) (A56805)
Billing and Coding: Monitored Anesthesia Care (A57361)
Billing and Coding: Nerve Conduction Studies and Electromyography (A54095)
Billing and Coding: Neurophysiology Evoked Potentials (NEPs) (A56773)
Billing and Coding: Oximetry Services (A57205)
Billing and Coding: Peripheral Venous Ultrasound (A52993)
Billing and Coding: Pharmacogenomics Testing (A58801)
Billing and Coding: Psychiatric Codes (A57130)
Billing and Coding: Removal of Benign Skin Lesions (A57113)
Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI) (A57600)
Billing and Coding: Speech-Language Pathology (SLP) Services: Communication Disorders (A54111)
Billing and Coding: Transesophageal Echocardiography (TEE) (A56505)
Billing and Coding: Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic) (A57414)
The following billing and coding article has been revised.
Billing and Coding: Molecular Pathology and Genetic Testing (A58917)
The following LCD which was posted for comment on June 6, has been posted for notice. The LCD and related billing and coding article will become effective December 1.
Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound (L39879)
Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound (A59766)
The following response to comments article contains summaries of all comments received and Novitas’ responses.
Response to Comments: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound (A59894)
The following billing and coding article has been revised.
Billing and Coding: Single Chamber and Dual Chamber Permanent Cardiac Pacemakers (A54982)
The comment period is now closed for the proposed LCD listed below. Comments received will be reviewed by our Contractor Medical Directors. The response to comments article will be posted to our website when the final LCD is posted for notice.
Transurethral Waterjet Ablation of the Prostate (DL38712)
The following proposed LCD has been posted for comment. The comment period will end on November 23; however, you are encouraged to submit your comments as soon as possible. When submitting your comments, we encourage you to submit literature/evidence supporting your recommendations for consideration. When submitting literature, you MUST submit the full-text article(s).
Botulinum Toxins (DL38809)
Billing and Coding: Botulinum Toxins (DA58423)
Submit Comments
As a reminder, the comment period for the following proposed LCD is currently open and will close on October 12. Please consider including literature/evidence in support of your request with your comments. We encourage you to submit your comments as soon as possible.
Transurethral Waterjet Ablation of the Prostate (DL38712)
Submit Comments
The following billing and coding article has been revised:
Billing and Coding: Ambulatory Electrocardiograph (AECG) Monitoring (A59268)
The Novitas Medical Policy team has evaluated all active local coverage articles for any impact in response to the 2025 annual ICD-10-CM code update. The following is a list of the impacted articles. The revised articles will be published to the MCD and on the Novitas website towards the end of October. Please continue to watch our website for updates.
Billing and Coding: Allergy Testing (A56558)
Billing and Coding: Bariatric Surgical Management of Morbid Obesity (A56422)
Billing and Coding: Biomarkers for Oncology (A52986)
Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing (A56645)
Billing and Coding: Cosmetic and Reconstructive Surgery (A56587)
Billing and Coding: Diagnostic Colonoscopy (A58428)
Billing and Coding: Electroretinography (ERG) (A56672)
Billing and Coding: Intensity Modulated Radiation Therapy (IMRT) (A56725)
Billing and Coding: Intraoperative Neurophysiological Testing (A56722)
Billing and Coding: Magnetic Resonance Angiography (MRA) (A56805)
Billing and Coding: Monitored Anesthesia Care (A57361)
Billing and Coding: Nerve Conduction Studies and Electromyography (A54095)
Billing and Coding: Neurophysiology Evoked Potentials (NEPs) (A56773)
Billing and Coding: Oximetry Services (A57205)
Billing and Coding: Peripheral Venous Ultrasound (A52993)
Billing and Coding: Pharmacogenomics Testing (A58801)
Billing and Coding: Psychiatric Codes (A57130)
Billing and Coding: Removal of Benign Skin Lesions (A57113)
Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI) (A57600)
Billing and Coding: Speech-Language Pathology (SLP) Services: Communication Disorders (A54111)
Billing and Coding: Transesophageal Echocardiography (TEE) (A56505)
Billing and Coding: Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic) (A57414)
Billing and Coding: Visual Field Examination (A57637)
The following billing and coding articles have been revised:
Billing and Coding: Esketamine (A59249)
Billing and Coding: Facet Joint Interventions for Pain Management (A56670)
Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A53252)
The following article which was posted for notice on July 18 became effective on September 1:
Self-Administered Drug Exclusion List (A53127)
The following proposed LCD has been posted for comment. The comment period will end on October 12; however, you are encouraged to submit your comments as soon as possible. When submitting your comments, we encourage you to submit literature/evidence supporting your recommendations for consideration. When submitting literature, you MUST submit the full-text article(s).
Transurethral Waterjet Ablation of the Prostate (DL38712)
Submit Comments
The following LCDs and related billing and coding articles which were posted for notice on June 27 became effective August 11:
Cervical Fusion (L39793)
Billing and Coding: Cervical Fusion (A59668)
Facet Joint Interventions for Pain Management (L34892)
Billing and Coding: Facet Joint Interventions for Pain Management (A56670)
Implantable Continuous Glucose Monitors (I-CGM) (L38617)
Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM) (A58110)
The following article has been revised:
Billing and Coding: Allergy Testing (A56558)
Novitas is considering all the feedback received from interested parties regarding the Genetic Testing for Oncology LCD. An extension has been granted by CMS in order for all comments to be considered thoroughly. Future updates will be published to this website and the Medicare Coverage Database. Please watch our website and consider subscribing to our mailing list for the most timely updates: Subscribe to our mailing list.
The comment period is now closed for the proposed LCD listed below. Comments received will be reviewed by our Contractor Medical Directors. The response to comments article will be posted to our website when the final LCD is posted for notice.
Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound (DL39879)
The following Billing and Coding articles have been revised to reflect the July 2024 CPT/HCPCS Code Quarterly updates effective for dates of service on and after July 1, 2024:
Billing and Coding: Allergy Testing (A56558)
Billing and Coding: Genetic Testing for Cardiovascular Disease (A58795)
Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A53252)
Billing and Coding: Molecular Pathology and Genetic Testing (A58917)
The following Article has been revised to reflect the July 2024 CPT/HCPCS Code Quarterly updates and will become effective September 1, 2024:
Self-Administered Drug Exclusion List: (A53127)
The comment period for the following proposed LCD will close on July 20. Please consider including literature/evidence in support of your request with your comments. We encourage you to submit your comments as soon as possible.
Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound (DL39879)
Submit Comments
The following article which was posted for notice on May 16 became effective on June 30.
Self-Administered Drug Exclusion List (A53127)
The following LCDs which were posted for comment on February 15, have been posted for notice. The LCDs and related billing and coding articles will become effective August 11. The following response to comments articles contain summaries of all comments received and Novitas’ responses.
Cervical Fusion (L39793)
Billing and Coding: Cervical Fusion (A59668)
Response to Comments: Cervical Fusion (A59802)
Facet Joint Interventions for Pain Management (L34892)
Billing and Coding: Facet Joint Interventions for Pain Management (A56670)
Response to Comments: Facet Joint Interventions for Pain Management (A59816)
Implantable Continuous Glucose Monitors (I-CGM) (L38617)
Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM) (A58110)
Response to Comments: Implantable Continuous Glucose Monitors (I-CGM) (A59832)
The comment period for Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non Wound (DL39879) is currently open and will close on July 20.
If you already submitted comments for this proposed LCD, and did not receive an acknowledgement, please re-submit them so that we can make sure they are taken into consideration.
Comments may be submitted here: Submit Comments
Please consider including literature/evidence in support of your request with your comments. We encourage you to submit your comments as soon as possible.
The following article has been revised:
Billing and Coding: Surgical Treatment of Nails (A52998)
The following article has been revised:
Billing and Coding: Surgical Treatment of Nails (A52998)
The comment period is now closed for the Proposed LCD listed below. Comments received will be reviewed by our Contractor Medical Directors. The Response to Comments Article will be posted to our website when the final LCD is posted for notice.
Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers (DL35041)
The following proposed LCD has been posted for comment. The comment period will end on July 20; however, you are encouraged to submit your comments as soon as possible. When submitting your comments, we encourage you to submit literature/evidence supporting your recommendations for consideration. When submitting literature, you MUST submit the full-text article(s).
Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound (DL39879)
Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound (DA59766)
Submit Comments
The comment period for the following proposed LCD will close on June 8. Please consider including literature/evidence in support of your request with your comments. We encourage you to submit your comments as soon as possible.
Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers (DL35041)
Submit Comments
The following billing and coding article has been revised:
Billing and Coding: 4Kscore Test Algorithm (A56653)
As a reminder, the comment period for the following proposed LCD is currently open and will close on June 8. Please consider including literature/evidence in support of your request with your comments. We encourage you to submit your comments as soon as possible.
Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers (DL35041)
Submit Comments
The following article has been revised:
Billing and Coding: Diagnostic Abdominal Aortography and Renal Angiography (A56682)
As a reminder, the comment period for the following proposed LCD is currently open and will close on June 8. Please consider including literature/evidence in support of your request with your comments. We encourage you to submit your comments as soon as possible.
Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers (DL35041)
Submit Comments
The following Article has been revised and will become effective June 30, 2024:
Self-Administered Drug Exclusion List (A53127)
The following proposed LCD has been posted for comment. The comment period will end on June 8; however, you are encouraged to submit your comments as soon as possible. When submitting your comments, we encourage you to submit literature/evidence supporting your recommendations for consideration. When submitting literature, you MUST submit the full-text article(s).
Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers (DL35041)
Billing and Coding: Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers (DA54117)
Submit Comments
The following billing and coding article has been revised:
Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A53252)
The following billing and coding articles have been revised:
Billing and Coding: Removal of Benign Skin Lesions (A57113)
Billing and Coding: Transesophageal Echocardiography (TEE) (A56505)
The following billing and coding articles have been revised:
Billing and Coding: Allergy Testing (A56558)
Billing and Coding: Botulinum Toxins (A58423)
Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A53252)
Billing and Coding: Molecular Pathology and Genetic Testing (A58917)
The following Local Coverage Determination (LCD) which was posted for notice February 15, 2024, became effective March 31, 2024:
Allergen Immunotherapy (L36240)
The comment period is now closed for the Proposed LCDs listed below. Comments received will be reviewed by our Contractor Medical Directors. The Response to Comments Articles will be posted to our website when the final LCDs are posted for notice.
Cervical Fusion (DL39793)
Facet Joint Interventions for Pain Management (DL34892)
Implantable Continuous Glucose Monitors (I-CGM) (DL38617)
The following article which was posted for notice on February 1 is now effective:
Self-Administered Drug Exclusion List (A53127)
As a reminder, the comment period for the following proposed LCDs is currently open and will close on March 30. Please consider including literature/evidence in support of your request with your comments. We encourage you to submit your comments as soon as possible.
Cervical Fusion (DL39793)
Facet Joint Interventions for Pain Management (DL34892)
Implantable Continuous Glucose Monitors (I-CGM) (DL38617)
The following billing and coding articles have been revised:
Billing and Coding: Immune Globulin (A56786)
Billing and Coding: Mohs Micrographic Surgery (MMS) (A53883)
As a reminder, the comment period for the following proposed LCDs is currently open and will close on March 30. Please consider including literature/evidence in support of your request with your comments. We encourage you to submit your comments as soon as possible.
Cervical Fusion (DL39793)
Facet Joint Interventions for Pain Management (DL34892)
Implantable Continuous Glucose Monitors (I-CGM) (DL38617)
The following LCD has been revised:
Psychiatric codes (L35101)
The following billing and coding article has been revised:
Billing and Coding: Biomarkers for Oncology (A52986)
The following LCD, which was posted for comment on September 28, 2023, has been posted for notice. The LCD will become effective March 31, 2024:
Allergen Immunotherapy (L36240)
The following response to comments article contains summaries of all comments received and Novitas’ responses:
Response to Comments: Allergen Immunotherapy (A59574)
The following proposed LCDs have been posted for comment. The comment period will end on March 30, 2024; however, you are encouraged to submit your comments as soon as possible. When submitting your comments, we encourage you to submit literature/evidence supporting your recommendations for consideration. When submitting literature you MUST submit the full-text article(s).
Cervical Fusion (DL39793)
Billing and Coding: Cervical Fusion (DA59668)
Facet Joint Interventions for Pain Management (DL34892)
Billing and Coding: Facet Joint Interventions for Pain Management (DA56670)
Implantable Continuous Glucose Monitors (I-CGM) (DL38617)
Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM) (DA58110)
The following billing and coding article has been revised:
Billing and Coding: Removal of Benign Skin Lesions (A57113)
The following article has been revised to reflect the 2024 annual CPT/HCPCS code updates effective for dates of service on and after January 1, 2024 and to reflect changes that will become effective March 17, 2024:
Self-Administered Drug Exclusion List (A53127)
The following LCD which was posted for notice on December 14, 2023 is now effective. The related billing and coding article for this LCD is also now effective:
Peripheral Venous Ultrasound (L35451)
Billing and Coding: Peripheral Venous Ultrasound (A52993)
The following articles have been revised to reflect the 2024 Annual CPT/HCPCS Code updates effective for dates of service on and after January 1, 2024:
Billing and Coding: Ambulatory Electrocardiograph (AECG) Monitoring (A59268)
Billing and Coding: Biomarkers for Oncology (A52986)
Billing and Coding: Biomarkers Overview (A56541)
Billing and Coding: Botulinum Toxins (A58423)
Billing and Coding: Genetic Testing for Cardiovascular Disease (A58795)
Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A53252)
Billing and Coding: Molecular Pathology and Genetic Testing (A58917)
Billing and Coding: Monitored Anesthesia Care (A57361)
Billing and Coding: Nerve Conduction Studies and Electromyography (A54095)
Billing and Coding: Pharmacogenomics Testing (A58801)
Billing and Coding: Psychiatric Codes (A57130)
Billing and Coding: Removal of Benign Skin Lesions (A57113)
Billing and Coding: Routine Foot Care (A52996)
Billing and Coding: Wound Care (A53001)
The following article which was posted for notice on November 30, 2023, became effective on January 14, 2024:
Self-Administered Drug Exclusion List (A53127)
The following billing and coding article has been added:
Billing and Coding: Treatment of Abnormal Uterine Bleeding with Intrauterine Device (Hormone-Eluting) (A59620)
The following LCD and billing and coding articles have been retired:
Neuromuscular Junction Testing (L34996)
Billing and Coding: Neuromuscular Junction Testing (A56785)
Billing and Coding: Complex Drug Administration Coding (A59073)
The following billing and coding article has been revised:
Billing and Coding: Removal of Benign Skin Lesions (A57113)
The following LCD which was posted for comment on August 3, 2023, has been posted for notice. The LCD and related billing and coding article will become effective January 28, 2024.
Peripheral Venous Ultrasound (L35451)
Billing and Coding: Peripheral Venous Ultrasound (A52993)
The following response to comments article contains summaries of all comments received and Novitas’ responses:
Response to Comments: Peripheral Venous Ultrasound (A59601)
The following billing and coding article has been revised:
Billing and Coding: eVox System and Other Electroencephalograph Testing for Memory Loss (A56440)
The following LCD, related billing and coding article and response to comments article have been retired:
Thrombolytic Agents (L35428)
Billing and Coding: Thrombolytic Agents (A55237)
Response to Comments: Thrombolytic Agents (A58012)
The following LCD which was posted for notice on October 26, 2023 became effective on December 10, 2023. The related billing and coding article for this LCD is also now effective:
Nerve Conduction Studies and Electromyography (L35081)
Billing and Coding: Nerve Conduction Studies and Electromyography (A54095)
The following billing and coding articles have been revised:
Billing and Coding: Diagnostic Abdominal Aortography and Renal Angiography (A56682)
Billing and Coding: Facet Joint Interventions for Pain Management (A56670)
Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions (A53134)
The following Article has been revised and will become effective January 14, 2024:
Self-Administered Drug Exclusion List (A53127)
The following billing and coding articles have been revised:
Billing and Coding: Approved Drugs and Biologicals; Includes Cancer Chemotherapeutic Agents (A53049)
Billing and Coding: Epidural Steroid Injections for Pain Management (A56681)
Billing and Coding: Micro-Invasive Glaucoma Surgery (MIGS) (A56633)
Billing and Coding: Surgical Treatment of Nails (A52998)
The comment period is now closed for the Proposed LCD listed below. Comments received will be reviewed by our Contractor Medical Directors. The Response to Comments Article will be posted to our website when the final LCD is posted for notice.
Allergen Immunotherapy (DL36240)
The following billing and coding article has been revised:
Billing and Coding: Botulinum Toxins (A58423)
The following billing and coding articles have been revised:
Billing and Coding: Approved Drugs and Biologicals; Includes Cancer Chemotherapeutic Agents (A53049)
Billing and Coding: Botulinum Toxins (A58423)
The following LCD and related Billing and Coding Article have been retired:
Implantable Infusion Pump (L35112)
Billing and Coding: Implantable Infusion Pump (A56778)
The following Billing and Coding Article has been retired:
Billing and Coding: Compounded Drugs Used in an Implantable Infusion Pump (A54100)
The following LCD posted for comment on June 1, 2023 has been posted for notice. The LCD and related Billing and Coding Article will become effective December 10, 2023.
Nerve Conduction Studies and Electromyography (L35081)
Billing and Coding: Nerve Conduction Studies and Electromyography (A54095)
The following Response to Comments Article contains summaries of all comments received and Novitas’ responses:
Response to Comments: Nerve Conduction Studies and Electromyography (A59566)
As a reminder, the comment period for the following proposed LCD is currently open and will close on November 11, 2023. Please consider including literature/evidence in support of your request with your comments. We encourage you to submit your comments as soon as possible.
Allergen Immunotherapy (DL36240)
Submit Comments
The following Billing and Coding Articles have been revised to reflect the Annual ICD-10 Code updates effective for dates of service on and after October 1, 2023:
Billing and Coding: Ambulatory Electrocardiograph (AECG) Monitoring (A59268)
Billing and Coding: Assays for Vitamins and Metabolic Function (A56416)
Billing and Coding: Bariatric Surgical Management of Morbid Obesity (A56422)
Billing and Coding: Biomarkers for Oncology (A52986)
Billing and Coding: Cardiac Rhythm Device Evaluation (A56602)
Billing and Coding: Cardiology Non-emergent Outpatient Stress Testing (A56423)
Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing (A56645)
Billing and Coding: Diagnostic Abdominal Aortography and Renal Angiography (A56682)
Billing and Coding: Electroretinography (ERG) (A56672)
Billing and Coding: Intensity Modulated Radiation Therapy (IMRT) (A56725)
Billing and Coding: Intraoperative Neurophysiological Testing (A56722)
Billing and Coding: Magnetic Resonance Angiography (MRA) (A56085)
Billing and Coding: Monitored Anesthesia Care (A57361)
Billing and Coding: Nerve Conduction Studies and Electromyography (A54095)
Billing and Coding: Neurophysiology Evoked Potentials (NEPs) (A56773)
Billing and Coding: Oximetry Services (A57205)
Billing and Coding: Pharmacogenomics Testing (A58801)
Billing and Coding: Psychiatric Codes (A57130)
Billing and Coding: Single Chamber and Dual Chamber Permanent Cardiac Pacemakers (A54982)
Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders (A54111)
Billing and Coding: Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography (A56631)
Billing and Coding: Transesophageal Echocardiography (TEE) (A56505)
Billing and Coding: Vestibular and Audiologic Function Studies (A57434)
The following LCD has been revised:
Epidural Steroid Injections for Pain Management (L36920)
The following Local Coverage Articles have been revised:
Billing and Coding: Hemophilia Factor Products (A56433)
Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A53252)
Billing and Coding: Molecular Pathology and Genetic Testing (A58917)
Self-Administered Drug Exclusion List: (A53127)
A Document Note has been added to the following Articles:
Billing and Coding: Ambulatory Electrocardiograph (AECG) Monitoring (A59268)
Billing and Coding: Cardiology Non-emergent Outpatient Stress Testing (A56423)
Please note: The Skin Substitute Grafts/Cellular and/or Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers (L35041/A54117) will not become effective on 10/01/2023.
A new Proposed LCD will be published for comment and presented at an Open Meeting in the near future.
In the meantime, current coverage has not changed. The following LCD and article remain in effect.
The Novitas Medical Policy team has evaluated all active local coverage articles for any impact in response to the 2024 annual ICD-10-CM code update. The following is a list of the impacted articles. The revised articles will be published to the MCD and on the Novitas website towards the end of October. Please continue to watch our website for updates.
Billing and Coding: Ambulatory Electrocardiograph (AECG) Monitoring (A59268)
Billing and Coding: Assays for Vitamins and Metabolic Function (A56416)
Billing and Coding: Bariatric Surgical Management of Morbid Obesity (A56422)
Billing and Coding: Biomarkers for Oncology (A52986)
Billing and Coding: Cardiac Rhythm Device Evaluation (A56602)
Billing and Coding: Cardiology Non-emergent Outpatient Stress Testing (A56423)
Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing (A56645)
Billing and Coding: Diagnostic Abdominal Aortography and Renal Angiography (A56682)
Billing and Coding: Electroretinography (ERG) (A56672)
Billing and Coding: Intensity Modulated Radiation Therapy (IMRT) (A56725)
Billing and Coding: Intraoperative Neurophysiological Testing (A56722)
Billing and Coding: Magnetic Resonance Angiography (MRA) (A56085)
Billing and Coding: Monitored Anesthesia Care (A57361)
Billing and Coding: Nerve Conduction Studies and Electromyography (A54095)
Billing and Coding: Neurophysiology Evoked Potentials (NEPs) (A56773)
Billing and Coding: Oximetry Services (A57205)
Billing and Coding: Pharmacogenomics Testing (A58801)
Billing and Coding: Psychiatric Codes (A57130)
Billing and Coding: Single Chamber and Dual Chamber Permanent Cardiac Pacemakers (A54982)
Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders (A54111)
Billing and Coding: Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography (A56631)
Billing and Coding: Transesophageal Echocardiography (TEE) (A56505)
Billing and Coding: Vestibular and Audiologic Function Studies (A57434)
The following LCD and related Billing and Coding Article, which were posted for notice on August 3, 2023, will not become effective at this time. Please refer to below NOTE:
Skin Substitute Grafts/Cellular and/or Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers (L35041)
Billing and Coding: Skin Substitute Grafts/Cellular and/or Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers (A54117)
NOTE: Please refer to the current LCD and related Article located on our website:
The following proposed LCD has been posted for comment. The comment period will end on November 11, 2023; however, you are encouraged to submit your comments as soon as possible. When submitting your comments, we encourage you to submit literature/evidence supporting your recommendations for consideration.
Allergen Immunotherapy (DL36240)
Submit Comments
The following billing and coding articles have been revised:
Billing and Coding: eVox® System and Other Electroencephalograph Testing for Memory Loss (A56440)
Billing and Coding: Mohs Micrographic Surgery (MMS) (A53883)
The following LCD and related Billing and Coding Article have been retired:
3D Interpretation and Reporting of Imaging Studies (L35408)
Billing and Coding: 3D Interpretation and Reporting of Imaging Studies (A56526)
The comment period is now closed for the following Proposed LCD. Comments received will be reviewed by our Contractor Medical Directors. The Response to Comments Article and finalized Billing and Coding Article will be related to the final LCD when it is posted for notice.
Peripheral Venous Ultrasound (DL35451)
The comment period is now closed for the following Proposed LCD. Comments received will be reviewed by our Contractor Medical Directors. The Response to Comments Article and finalized Billing and Coding Article will be related to the final LCD when it is posted for notice.
Genetic Testing for Oncology (DL39365)
As a reminder, the comment period for the following proposed LCD is currently open and will close on September 16, 2023. Please consider including literature/evidence in support of your request with your comments. We encourage you to submit your comments as soon as possible.
Peripheral Venous Ultrasound (DL35451)
Submit Comments
The following article which was posted for notice on July 20, 2023, became effective on September 3, 2023:
Self-Administered Drug Exclusion List (A53127)
As a reminder, the comment period for the following proposed LCD is currently open and will close on September 9, 2023. Please consider including literature/evidence in support of your request with your comments. We encourage you to submit your comments as soon as possible.
Genetic Testing for Oncology (DL39365)
Submit Comments
The following billing and coding articles have been revised:
Billing and Coding: Ambulatory Electrocardiograph (AECG) Monitoring (A59268)
Billing and Coding: Biomarkers for Oncology (A52986)
Billing and Coding: Cardiology Non-emergent Outpatient Stress Testing (A56423)
The following LCD and related Billing and Coding Article have been retired:
Non-Vascular Extremity Ultrasound (L35409)
Billing and Coding: Non-Vascular Extremity Ultrasound (A55037)
The following LCD which posted for comment on April 14, 2022, and on August 11, 2022, has been posted for notice. The LCD and related Billing and Coding Article will become effective September 17, 2023.
Skin Substitute Grafts/Cellular and/or Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers (L35041)
Billing and Coding: Skin Substitute Grafts/Cellular and/or Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers (A54117)
The following Response to Comments Article contains summaries of all comments received and Novitas’ responses:
Response to Comments: Skin Substitute Grafts/Cellular and/or Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers (A59517)
The following proposed LCD has been posted for comment. The comment period will end on September 16, 2023; however, you are encouraged to submit your comments as soon as possible. When submitting your comments, we encourage you to submit literature/evidence supporting your recommendations for consideration.
Peripheral Venous Ultrasound (DL35451)
Billing and Coding: Peripheral Venous Ultrasound (DA52993)
Submit Comments
The following Billing and Coding Articles have been revised:
Billing and Coding: Botulinum Toxins (A58423)
Billing and Coding: Complex Drug Administration Coding (A59073)
Billing and Coding: Thrombolytic Agents (A55237)
The following proposed LCD has been posted for comment. The comment period will end on September 9, 2023; however, you are encouraged to submit your comments as soon as possible. When submitting your comments, we encourage you to submit literature/evidence supporting your recommendations for consideration.
Genetic Testing for Oncology (DL39365)
Submit Comments
The following Draft Billing and Coding Article is related to the above Proposed LCD.
Genetic Testing for Oncology (DA59125)
The following Billing and Coding Articles have been revised:
Billing and Coding: Genetic Testing for Cardiovascular Disease (A58795)
Billing and Coding: Immune Globulin (A56786)
Billing and Coding: Hemophilia Factor Products (A56433)
Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A53252)
Billing and Coding: Micro-Invasive Glaucoma Surgery (MIGS) (A56633)
Billing and Coding: Molecular Pathology and Genetic Testing (A58917)
Billing and Coding: Pharmacogenomics Testing (A58801)
Billing and Coding: Platelet Rich Plasma (A58808)
The following Article has been revised to reflect the July 2023 CPT/HCPCS Code Quarterly updates and will become effective September 3, 2023:
Self-Administered Drug Exclusion List (A53127)
The comment period is now closed for the following Proposed LCD. Comments received will be reviewed by our Contractor Medical Directors. The Response to Comments Article and finalized Billing and Coding Article will be related to the final LCD when it is posted for notice.
Nerve Conduction Studies and Electromyography (DL35081)
The following LCD and related Billing and Coding Article have been retired:
Spinal Cord Stimulation (Dorsal Column Stimulation) (L35450)
Billing and Coding: Spinal Cord Stimulation (Dorsal Column Stimulation) (A57023)
As a reminder, the comment period for the following proposed LCD is currently open and will close on July 15, 2023. Please consider including literature/evidence in support of your request with your comments. We encourage you to submit your comments as soon as possible.
Nerve Conduction Studies and Electromyography (DL35081)
Submit Comments
The following LCD and related Billing and Coding Article, which was posted for Notice on June 2, 2023, will not become effective on July 17, 2023 as previously communicated. A new Proposed LCD will be published for comment and presented at an Open Meeting in the near future. Please continue to watch our website for updates.
Genetic Testing for Oncology (L39365)
Billing and Coding: Genetic Testing for Oncology (A59125)
The following LCDs will remain in effect at this time:
Biomarkers for Oncology (L35396)
Billing and Coding: Biomarkers for Oncology (A52986)
Biomarkers Overview (L35062)
Billing and Coding: Biomarkers Overview (A56541)
BRCA1 and BRCA2 Genetic Testing (L36715)
Billing and Coding: BRCA1 and BRCA2 Genetic Testing (A56542)
Loss-of Heterozygosity Based Topographic Genotyping with Pathfinder TG (L34864)
Billing and Coding: Loss-of Heterozygosity Based Topographic Genotyping with Pathfinder TG (A56897)
The following Billing and Coding Article has been revised:
Billing and Coding: Transcranial Magnetic Stimulation (TMS) in the Treatment of Adults with Major Depressive Disorder (A57072)
As a reminder, the comment period for the following proposed LCD is currently open and will close on July 15, 2023. Please consider including literature/evidence in support of your request with your comments. We encourage you to submit your comments as soon as possible.
Nerve Conduction Studies and Electromyography (DL35081)
Submit Comments
The following articles which were posted for notice on May 11, 2023 are now effective:
Billing and Coding: Blepharoplasty, Blepharoptosis Repair and Surgical Procedures of the Brow (A57618)
Self-Administered Drug Exclusion List (A53127)
The following Billing and Coding Article has been revised:
Billing and Coding: Removal of Benign Skin Lesions (A57113)
The following LCD and related Billing and Coding Article have been retired:
Barium Swallow Studies, Modified (L35433)
Billing and Coding: Barium Swallow Studies, Modified (A56589)
The following LCD, which was posted for notice on April 27, 2023, became effective on June 11, 2023. The related billing and coding article for this LCD is also now effective:
Ambulatory Electrocardiograph (AECG) Monitoring (L39490)
Billing and Coding: Ambulatory Electrocardiograph (AECG) Monitoring (A59268)
The following Billing and Coding Article, which was revised and published on April 27, 2023, is now effective:
Billing and Coding: Molecular Pathology and Genetic Testing (A58917)
The following Billing and Coding Article has been revised:
Billing and Coding: Approved Drugs and Biologicals; Includes Cancer Chemotherapeutic Agents (A53049)
The following Billing and Coding Article has been revised and will become effective June 11, 2023:
Billing and Coding: Molecular Pathology and Genetic Testing (A58917)
The following LCD and related Billing and Coding Article has been retired:
Pulmonary Function Testing (L35360)
Billing and Coding: Pulmonary Function Testing (A57320)
The following LCDs and related Billing and Coding Articles are being retired effective for dates of service on and after June 11, 2023:
Cardiac Event Detection Monitoring (L34953)
Billing and Coding: Cardiac Event Detection Monitoring (A56600)
Real-Time, Outpatient Cardiac Telemetry (L34997)
Billing and Coding: Real-Time, Outpatient Cardiac Telemetry (A52995)
The following LCD posted for comment on June 9, 2022 has been posted for notice. The LCD and related Billing and Coding Article will become effective July 17, 2023.
Genetic Testing for Oncology (L39365)
Billing and Coding: Genetic Testing for Oncology (A59125)
The following Response to Comments Article contains summaries of all comments received and Novitas’ responses:
Response To Comments: Genetic Testing for Oncology (A59417)
The following proposed LCD has been posted for comment. The comment period will end on July 15, 2023; however, you are encouraged to submit your comments as soon as possible. When submitting your comments, we encourage you to submit literature/evidence supporting your recommendations for consideration.
Nerve Conduction Studies and Electromyography (DL35081)
Submit Comments
The following Draft Billing and Coding Article is related to the above Proposed LCD.
Billing and Coding: Nerve Conduction Studies and Electromyography (DA54095)
The following Billing and Coding Article has been revised:
Billing and Coding: Immune Globulin (A56786)
Novitas and First Coast greatly appreciate the comments and evidence we received as a result of the multi-jurisdictional Contractor Advisory Committee (CAC) meeting that was held on February 28, 2023, regarding Remote Physiologic Monitoring (RPM) and Remote Therapeutic Monitoring (RTM) for Non-implantable Devices. After careful consideration, Novitas Solutions and First Coast Service Options will not develop a Local Coverage Determination (LCD) for RPM and RTM for Non-implantable Devices. All the information and feedback received, along with any new evidence that becomes available, will be carefully considered if we decide to develop an LCD in the future.
Please keep in mind that Novitas and First Coast do not have a policy to match every procedure code, diagnosis code, or service reportable to Medicare. In some instances, we may have an LCD that is not applicable to all providers or services. In the absence of an LCD, NCD, or CMS Manual Instruction; reasonable and necessary guidelines still apply to any service reported to Medicare.
Although not required, Novitas is providing a 45-day notice of the revisions to the following article before the changes become effective on June 25, 2023:
Billing and Coding: Blepharoplasty, Blepharoptosis Repair and Surgical Procedures of the Brow (A57618)
The following Article has been revised and will become effective June 25, 2023:
Self-Administered Drug Exclusion List (A53127)
The following LCD and related Billing and Coding Article have been retired:
Non-Coronary Vascular Stents (L35084)
Billing and Coding: Non-Coronary Vascular Stents (A56365)
The following Proposed LCD and related Draft Billing and Coding Article have been retired and will not be finalized. Please refer to the current LCD and related Article located on our website:
Nerve Stimulators for Chronic Intractable Pain (DL39404)
Billing and Coding: Nerve Stimulators for Chronic Intractable Pain (DA59188)
The following LCD, which posted for comment on October 13, 2022, has been posted for notice. The LCD and related Billing and Coding Article will become effective June 11, 2023.
Ambulatory Electrocardiograph (AECG) Monitoring (L39490)
Billing and Coding: Ambulatory Electrocardiograph (AECG) Monitoring (A59268)
The following Response to Comments Article contains summaries of all comments received and Novitas’ responses:
Response to Comments: Ambulatory Electrocardiograph (AECG) Monitoring (A59366)
The following Billing and Coding Article has been revised to become effective June 11.
Billing and Coding: Molecular Pathology and Genetic Testing (A58917)
The following Billing and Coding Article has been revised:
Billing and Coding: Pharmacogenomics Testing (A58801)
The following LCDs and related Billing and Coding Articles have been retired:
Anorectal Manometry, Anal Electromyography, and Biofeedback Training for Perineal Muscles and Anorectal or Urethral Sphincters (L34977)
Billing and Coding: Anorectal Manometry, Anal Electromyography, and Biofeedback Training for Perineal Muscles and Anorectal or Urethral Sphincters (A56530)
Flow Cytometry (L35032)
Billing and Coding: Flow Cytometry (A56676)
The following Billing and Coding Article has been retired:
Billing and Coding: Ventricular Assist Device (VAD) Supply or Accessory (A54910)
The following Billing and Coding Articles have been revised:
Billing and Coding: Botulinum Toxins (A58423)
Billing and Coding: Complex Drug Administration Coding (A59073)
Billing and Coding: Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs) (A56642)
Billing and Coding: Intraoperative Neurophysiological Testing (A56722)
Billing and Coding: Molecular Pathology and Genetic Testing (A58917)
Billing and Coding: Respiratory Pathogen Panel Testing (A58575)
The following Billing and Coding Article has been revised:
Billing and Coding: Surgical Treatment of Nails (A52998)
The following LCD and related Billing and Coding Article have been retired:
Hyaluronan Acid Therapies for Osteoarthritis of the Knee (L35427)
Billing and Coding: Hyaluronan Acid Therapies for Osteoarthritis of the Knee (A55036)
The following Proposed LCD and related Draft Billing and Coding Article have been retired and will not be finalized. Please refer to the current LCD and related Article located on our website:
Controlled Substance Monitoring and Drugs of Abuse Testing (DL35006)
Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing (DA56645)
The following Billing and Coding Articles have been revised:
Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing (A56645)
Billing and Coding: Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic) (A57414)
The following LCDs and related Billing and Coding Articles have been retired:
Hydration Therapy (L34960)
Billing and Coding: Hydration Therapy (A56634)
Therapy and Rehabilitation Services (PT, OT) (L35036)
Billing and Coding: Therapy and Rehabilitation Services (PT, OT) (A57703)
The following Billing and Coding Article has been retired:
Billing and Coding: Information Regarding Uses, Including Off-Label Uses of Anti-Vascular Endothelial Growth Factor (anti-VEGF), for The Treatment of Ophthalmological Diseases (A53121)
The following Local Coverage Article, which was posted for notice on February 9, 2023, is now effective:
Self-Administered Drug Exclusion List (A53127)
The following articles have been retired:
Billing and Coding: Acute Care: Inpatient, Observation and Treatment Room Services (A52985)
Billing and Coding: Laboratory Panels (A56473)
Billing and Coding: Prepackaged Kits (A54515)
Billing and Coding: Rezum® Procedure (A55352)
The following Billing and Coding Article has been revised:
Billing and Coding: Pharmacogenomics Testing (A58801)
The following Billing and Coding Articles have been revised:
Billing and Coding: Allergy Testing (A56558)
Billing and Coding: Information Regarding Uses, Including Off-Label Uses of Anti-Vascular Endothelial Growth Factor (anti-VEGF), for The Treatment of Ophthalmological Diseases (A53121)
The following Article has been revised and will become effective March 27, 2023:
Self-Administered Drug Exclusion List (A53127)
The following Billing and Coding Article has been revised:
Billing and Coding: Facet Joint Interventions for Pain Management (A56670)
The following LCDs and related Billing and Coding Articles have been retired:
Ambulance Services (Ground Ambulance) (L35162)
Billing and Coding: Ambulance Services (Ground Ambulance) (A54574)
Surgery: Posterior Tibial Nerve Stimulation (PTNS) for Urinary Control (L35011)
Billing and Coding: Surgery: Posterior Tibial Nerve Stimulation (PTNS) for Urinary Control (A57712)
The following LCD, which was posted for notice on December 22, 2022, became effective on February 5, 2023. The related billing and coding article for this LCD is also now effective:
Immune Globulin (L35093)
Billing and Coding: Immune Globulin (A56786)
The following articles have been revised to reflect the 2023 Annual CPT/HCPCS Code updates effective for dates of service on and after January 1, 2023:
Billing and Coding: Acute Care: Inpatient, Observation and Treatment Room Services (A52985)
Billing and Coding: Assays for Vitamins and Metabolic Function (A56416)
Billing and Coding: Auricular Peripheral Nerve Stimulation (Electro-Acupuncture Device) (A55240)
Billing and Coding: Autonomic Function Tests (A54954)
Billing and Coding: Bariatric Surgical Management of Morbid Obesity (A56422)
Billing and Coding: Biomarkers for Oncology (A52986)
Billing and Coding: Cardiology Non-emergent Outpatient Stress Testing (A56423)
Billing and Coding: Complex Drug Administration Coding (A59073)
Billing and Coding: Endovenous Stenting (A56414)
Billing and Coding: eVox® System and Other Electroencephalograph Testing for Memory Loss (A56440)
Billing and Coding: Facet Joint Interventions for Pain Management (A56670)
Billing and Coding: Frequency of Hemodialysis (A55723)
Billing and Coding: Frequency of Laboratory Tests (A56420)
Billing and Coding: Hyaluronan Acid Therapies for Osteoarthritis of the Knee (A55036)
Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM) (A58110)
Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A53252)
Billing and Coding: Information Regarding Uses, Including Off-Label Uses of Anti-Vascular Endothelial Growth Factor (anti-VEGF), for The Treatment of Ophthalmological Diseases (A53121)
Billing and Coding: Molecular Pathology and Genetic Testing (A58917)
Billing and Coding: Nerve Conduction Studies and Electromyography (A54095)
Billing and Coding: Non-Vascular Extremity Ultrasound (A55037)
Billing and Coding: Outpatient Sleep Studies (A56923)
Billing and Coding: Pharmacogenomics Testing (A58801)
Billing and Coding: Prolonged Drug and Biological Infusions Started Incident to a Physician’s Service Using an External Pump (A55134)
Billing and Coding: Psychiatric Codes (A57130)
Billing and Coding: Respiratory Pathogen Panel Testing (A58575)
Billing and Coding: Therapy and Rehabilitation Services (PT, OT) (A57703)
Billing and Coding: Urodynamic Services - Non-invasive (A58541)
The following LCD and related article have been retired effective for dates of service on and after January 1, 2023:
Evaluation and Management Services Provided in a Nursing Facility (L35068)
Billing and Coding: Evaluation and Management Services Provided in a Nursing Facility (A56712)
The Novitas Solutions’ Medical Policy team has evaluated all active Local Coverage Articles for any impact in response to the 2023 Annual HCPCS/CPT Code Update. The following is a list of the impacted Articles. The revised Articles will be published to the Medicare Coverage Database and on our Website in January. Please continue to watch our website for updates.
Billing and Coding: Acute Care: Inpatient, Observation and Treatment Room Services (A52985)
Billing and Coding: Assays for Vitamins and Metabolic Function (A56416)
Billing and Coding: Auricular Peripheral Nerve Stimulation (Electro-Acupuncture Device) (A55240)
Billing and Coding: Autonomic Function Tests (A54954)
Billing and Coding: Bariatric Surgical Management of Morbid Obesity (A56422)
Billing and Coding: Biomarkers for Oncology (A52986)
Billing and Coding: Cardiology Non-emergent Outpatient Stress Testing (A56423)
Billing and Coding: Complex Drug Administration Coding (A59073)
Billing and Coding: Endovenous Stenting (A56414)
Billing and Coding: eVox® System and Other Electroencephalograph Testing for Memory Loss (A56440)
Billing and Coding: Facet Joint Interventions for Pain Management (A56670)
Billing and Coding: Frequency of Hemodialysis (A55723)
Billing and Coding: Frequency of Laboratory Tests (A56420)
Billing and Coding: Hyaluronan Acid Therapies for Osteoarthritis of the Knee (A55036)
Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM) (A58110)
Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A53252)
Billing and Coding: Information Regarding Uses, Including Off-Label Uses, of Anti-Vascular Endothelial Growth Factor (anti-VEGF), for The Treatment of Ophthalmological Diseases (A53121)
Billing and Coding: Molecular Pathology and Genetic Testing (A58917)
Billing and Coding: Nerve Conduction Studies and Electromyography (A54095)
Billing and Coding: Non-Vascular Extremity Ultrasound (A55037)
Billing and Coding: Outpatient Sleep Studies (A56923)
Billing and Coding: Pharmacogenomics Testing (A58801)
Billing and Coding: Prolonged Drug and Biological Infusions Started Incident to a Physician’s Service Using an External Pump (A55134)
Billing and Coding: Psychiatric Codes (A57130)
Billing and Coding: Respiratory Pathogen Panel Testing (A58575)
Billing and Coding: Therapy and Rehabilitation Services (PT, OT) (A57703)
Billing and Coding: Urodynamic Services - Non-invasive (A58541)
The following LCD posted for comment on August 11, 2022, has been posted for notice. The LCD and related Billing and Coding Article will become effective February 5, 2023.
Immune Globulin (L35093)
Billing and Coding: Immune Globulin (A56786)
The following Response to Comments Article contains summaries of all comments received and Novitas’ responses:
Response to Comments: Immune Globulin (A59283)
The following Billing and Coding Article has been revised:
Billing and Coding: Allergen Immunotherapy (A56538)
The following Local Coverage Determination (LCD) which was posted for notice on October 27, 2022 is now effective. The related billing and coding article for this LCD is also now effective:
Transcranial Magnetic Stimulation (TMS) in the Treatment of Adults with Major Depressive Disorder (L34998)
Billing and Coding: Transcranial Magnetic Stimulation (TMS) in the Treatment of Adults with Major Depressive Disorder (A57072)
The following Billing and Coding articles have been revised:
Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A53252)
Billing and Coding: Intravenous Immune Globulin (IVIG) (A56786)
The comment period is now closed for the following Proposed LCDs. Comments received will be reviewed by our Contractor Medical Directors. The Response to Comments Articles and finalized Billing and Coding Articles will be related to the final LCDs when they are posted for notice.
Ambulatory Electrocardiograph (AECG) Monitoring (DL39490)
Controlled Substance Monitoring and Drugs of Abuse Testing (DL35006)
As a reminder, the comment period for the following proposed LCDs is currently open and will close on November 26, 2022. Please consider including literature/evidence in support of your request with your comments. We encourage you to submit your comments as soon as possible.
Ambulatory Electrocardiograph (AECG) Monitoring (DL39490)
Controlled Substance Monitoring and Drugs of Abuse Testing (DL35006)
Submit Comments
The following Billing and Coding articles have been revised:
Billing and Coding: Biomarkers Overview (A56541)
Billing and Coding: eVox® System and Other Electroencephalograph Testing for Memory Loss (A56440)
The following LCD and related Billing and Coding Article have been retired:
Luteinizing Hormone-Releasing Hormone (LHRH) Analogs (L34822)
Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs (A56776)
The following articles which were posted for notice on September 29, 2022 became effective November 14, 2022.
Billing and Coding: Esketamine (A59249)
Self-Administered Drug Exclusion List (A53127)
The following LCD posted for comment on June 9, 2022, has been posted for notice. The LCD and related Billing and Coding Article will become effective December 11, 2022.
Transcranial Magnetic Stimulation (TMS) in the Treatment of Adults with Major Depressive Disorder (L34998)
Billing and Coding: Transcranial Magnetic Stimulation (TMS) in the Treatment of Adults with Major Depressive Disorder (A57072)
The following Response to Comments Article contains summaries of all comments received and Novitas’ responses:
Response To Comments: Transcranial Magnetic Stimulation (TMS) in the Treatment of Adults with Major Depressive Disorder (A59262)
The following Billing and Coding Articles have been revised to reflect the Annual ICD-10 Code updates effective for dates of service on and after October 1, 2022:
Billing and Coding: Ambulance Services (Ground Ambulance) (A54574)
Billing and Coding: Assays for Vitamins and Metabolic Function (A56416)
Billing and Coding: Cardiac Event Detection Monitoring (A56600)
Billing and Coding: Cardiac Rhythm Device Evaluation (A56602)
Billing and Coding: Cardiology Non-emergent Outpatient Stress Testing (A56423)
Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing (A56645)
Billing and Coding: Diagnostic Abdominal Aortography and Renal Angiography (A56682)
Billing and Coding: Flow Cytometry (A56676)
Billing and Coding: Frequency of Hemodialysis (A55723)
Billing and Coding: Intensity Modulated Radiation Therapy (IMRT) (A56725)
Billing and Coding: Intraoperative Neurophysiological Testing (A56722)
Billing and Coding: Intravenous Immune Globulin (IVIG) (A56786)
Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs (A56776)
Billing and Coding: Magnetic Resonance Angiography (MRA) (A56805)
Billing and Coding: Monitored Anesthesia Care (A57361)
Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions (A53134)
Billing and Coding: Nerve Conduction Studies and Electromyography (A54095)
Billing and Coding: Oximetry Services (A57205)
Billing and Coding: Pharmacogenomics Testing (A58801)
Billing and Coding: Psychiatric Codes (A57130)
Billing and Coding: Pulmonary Function Testing (A57320)
Billing and Coding: Real-Time, Outpatient Cardiac Telemetry (A52995)
Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders (A54111)
Billing and Coding: Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography (A56631)
Billing and Coding: Transesophageal Echocardiography (TEE) (A56505)
The following Billing and Coding Article has been revised effective for dates of service on and after October 1, 2022:
Billing and Coding: Hemophilia Factor Products (A56433)
The following LCD has been retired effective October 1, 2022:
Hemophilia Factor Products (L35111)
The following LCD, which was posted for notice on September 1, 2022, became effective on October 16, 2022. The related billing and coding article for this LCD is also effective:
Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Amplification Techniques (NAATs) (L38229)
Billing and Coding: Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs) (A56642)
The following proposed LCDs have been posted for comment. The comment period will end on November 26, 2022; however, you are encouraged to submit your comments as soon as possible. When submitting your comments, we encourage you to submit literature/evidence supporting your recommendations for the Novitas Solutions Contractor Medical Directors to consider.
Ambulatory Electrocardiograph (AECG) Monitoring (DL39490)
Controlled Substance Monitoring and Drugs of Abuse Testing (DL35006)
Submit Comments
The following Draft Billing and Coding Articles are related to the above Proposed LCDs.
Billing and Coding: Ambulatory Electrocardiograph (AECG) Monitoring (DA59268)
Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing (DA56645)
The following Billing and Coding article has been revised.
Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A53252)
The following Billing and Coding Articles have been revised:
Billing and Coding: Biomarkers for Oncology (A52986)
Billing and Coding: Molecular Pathology and Genetic Testing (A58917)
The following Billing and Coding Article has been added to become effective November 14, 2022:
Billing and Coding: Esketamine (A59249)
The following Article has been revised and will become effective November 14, 2022:
Self-Administered Drug Exclusion List (A53127)
The following Billing and Coding Article has been revised:
Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A53252)
The Novitas Solutions Medical Policy Team has evaluated all active Local Coverage Articles for any impact in response to the 2023 Annual ICD-10 Code Update. The following is a list of the impacted articles. The revised articles will be published to the Medicare Coverage Database and on the Novitas Website in the middle of October. Please continue to watch our website for updates.
Billing and Coding: Ambulance Services (Ground Ambulance) (A54574)
Billing and Coding: Assays for Vitamins and Metabolic Function (A56416)
Billing and Coding: Cardiac Event Detection Monitoring (A56600)
Billing and Coding: Cardiac Rhythm Device Evaluation (A56602)
Billing and Coding: Cardiology Non-emergent Outpatient Stress Testing (A56423)
Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing (A56645)
Billing and Coding: Diagnostic Abdominal Aortography and Renal Angiography (A56682)
Billing and Coding: Flow Cytometry (A56676)
Billing and Coding: Frequency of Hemodialysis (A55723)
Billing and Coding: Intensity Modulated Radiation Therapy (IMRT) (A56725)
Billing and Coding: Intraoperative Neurophysiological Testing (A56722)
Billing and Coding: Intravenous Immune Globulin (IVIG) (A56786)
Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs (A56776)
Billing and Coding: Magnetic Resonance Angiography (MRA) (A56805)
Billing and Coding: Monitored Anesthesia Care (A57361)
Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions (A53134)
Billing and Coding: Nerve Conduction Studies and Electromyography (A54095)
Billing and Coding: Oximetry Services (A57205)
Billing and Coding: Pharmacogenomics Testing (A58801)
Billing and Coding: Psychiatric Codes (A57130)
Billing and Coding: Pulmonary Function Testing (A57320)
Billing and Coding: Real-Time, Outpatient Cardiac Telemetry (A52995)
Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders (A54111)
Billing and Coding: Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography (A56631)
Billing and Coding: Transesophageal Echocardiography (TEE) (A56505)
The comment period is now closed for the following Proposed LCDs. Comments received will be reviewed by our Contractor Medical Directors. The Response to Comments Articles and finalized Billing and Coding Articles will be related to the final LCDs when they are posted for notice.
Immune Globulin (DL35093)
Nerve Stimulators for Chronic Intractable Pain (DL39404)
Skin Substitutes for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers (DL35041)
The following Local Coverage Article, which was posted for notice on August 4, 2022, is now effective:
Self-Administered Drug Exclusion List (A53127)
As a reminder, the comment period for the following proposed LCDs is currently open and will close on September 24, 2022. Please consider including literature/evidence in support of your request with your comments. We encourage you to submit your comments as soon as possible.
Immune Globulin (DL35093)
Nerve Stimulators for Chronic Intractable Pain (DL39404)
Skin Substitutes for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers (DL35041)
Submit Comments
The comment period is now closed for the following Proposed LCD. Comments received will be reviewed by our Contractor Medical Directors. The Response to Comments Article and finalized Billing and Coding Article will be related to the final LCD when it is posted for notice.
Genetic Testing for Oncology (DL39365)
The following LCD posted for comment on April 14, 2022 has been posted for notice. The LCD and related Billing and Coding Article will become effective October 16, 2022.
Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs) (L38229)
Billing and Coding: Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs) (A56642)
The following Response to Comments Article contains summaries of all comments received and Novitas’ responses:
Response to Comments: Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs) (A59197)
The following LCD has been revised:
Trigger Point Injections (L35010)
The following LCD posted for comment on April 14, 2022 was reposted for comment on August 11, 2022. The comment period will end on September 24, 2022.
Skin Substitutes for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers (DL35041)
The following Draft Billing and Coding Article is related to the above Proposed LCD.
Billing and Coding: Skin Substitutes for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers (DA54117)
As a reminder, the comment period for the following proposed LCD is currently open and will close on September 6, 2022. Please consider including literature/evidence in support of your request with your comments. We encourage you to submit your comments as soon as possible.
Genetic Testing for Oncology (DL39365)
The following proposed LCDs have been posted for comment. The comment period will end on September 24, 2022; however, you are encouraged to submit your comments as soon as possible. When submitting your comments, we encourage you to submit literature/evidence supporting your recommendations for the Novitas Solutions Contractor Medical Directors to consider.
Immune Globulin (DL35093)
Nerve Stimulators for Chronic Intractable Pain (DL39404)
Skin Substitutes for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers (DL35041)
The following Draft Billing and Coding Articles are related to the above Proposed LCDs.
Billing and Coding: Immune Globulin (DA56786)
Billing and Coding: Nerve Stimulators for Chronic Intractable Pain (DA59188)
Billing and Coding: Skin Substitutes for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers (DA54117)
The following Billing and Coding Articles have been revised:
Billing and Coding: Complex Drug Administration Coding (A59073)
Billing and Coding: Monitored Anesthesia Care (A57361)
The following Billing and Coding articles have been revised to reflect the July 2022 CPT/HCPCS Code Quarterly updates and/or in response to inquiries:
Billing and Coding: Biomarkers for Oncology (A52986)
Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM) (A58110)
Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A53252)
Billing and Coding: Information Regarding Uses, Including Off-Label Uses, of Anti-Vascular Endothelial Growth Factor (anti-VEGF), for The Treatment of Ophthalmological Diseases (A53121)
Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs (A56776)
Billing and Coding: Molecular Pathology and Genetic Testing (A58917)
Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions (A53134)
Billing and Coding: Pharmacogenomics Testing (A58801)
Billing and Coding: Respiratory Pathogen Panel Testing (A58575)
The following Article has been revised effective for dates of service on and after September 19, 2022.
Self-Administered Drug Exclusion List: (A53127)
As indicated on July 25, 2022, the comment period for Genetic Testing for Oncology has been extended until September 6, 2022, due to changes that are being made to the final billing and coding article. Detailed information regarding the changes to the article is now visible on the document notes at the top of the proposed LCD and Draft Article.
Please refer to the Related Local Coverage Documents section at the bottom of the Proposed LCD for changes made to the draft article (DA59125, Billing and Coding: Genetic Testing for Oncology).
Genetic Testing for Oncology (DL39365)
Billing and Coding: Genetic Testing for Oncology (DA59125)
The comment period for the following Proposed LCD has been extended until September 6, 2022, due to changes that will be made to the Final Related Billing and Coding Article. The change in the comment end date along with detailed information regarding the changes to the article will be visible on the Medicare Coverage Database (MCD) and our website on July 28, 2022. The information will be located on the Document Note at the top of the proposed LCD and on the Document Note at the top of the draft Article. Please check our website on July 28, 2022, for this information.
Please do not re-submit comments already submitted, but we welcome additional comments related to the changes.
Genetic Testing for Oncology (DL39365)
The comment period is now closed for the following Proposed LCD. Comments received will be reviewed by our Contractor Medical Directors. The Response to Comments Article and finalized Billing and Coding Article will be related to the final LCD when it is posted for notice.
Transcranial Magnetic Stimulation (TMS) in the Treatment of Adults with Major Depressive Disorder (DL34998)
As a reminder, the comment period for the following proposed LCDs is currently open and will close on July 23, 2022. Please consider including literature/evidence in support of your request with your comments. We encourage you to submit your comments as soon as possible.
Genetic Testing for Oncology (DL39365)
Transcranial Magnetic Stimulation (TMS) in the Treatment of Adults with Major Depressive Disorder (DL34998)
As a reminder, the comment period for the following proposed LCDs is currently open and will close on July 23, 2022. Please consider including literature/evidence in support of your request with your comments. We encourage you to submit your comments as soon as possible.
Genetic Testing for Oncology (DL39365)
Transcranial Magnetic Stimulation (TMS) in the Treatment of Adults with Major Depressive Disorder (DL34998)
The following billing and coding article has been revised.
Billing and Coding: Lower Extremity Major Joint Replacement (Hip and Knee) (A56796)
The following proposed LCDs have been posted for comment. The comment period will end on July 23, 2022; however, you are encouraged to submit your comments as soon as possible. When submitting your comments, we encourage you to submit literature/evidence supporting your recommendations for the Novitas Solutions Contractor Medical Directors to consider.
Genetic Testing for Oncology (DL39365)
Transcranial Magnetic Stimulation (TMS) in the Treatment of Adults with Major Depressive Disorder (DL34998)
The following Draft Billing and Coding Articles are related to the above Proposed LCDS.
Billing and Coding: Genetic Testing for Oncology (DA59125)
Billing and Coding: Transcranial Magnetic Stimulation (TMS) in the Treatment of Adults with Major Depressive Disorder (DA57072)
The following billing and coding article has been revised:
Billing and Coding: Information Regarding Uses, Including Off-Label Uses, of Anti-Vascular Endothelial Growth Factor (anti-VEGF), for the Treatment of Ophthalmological Diseases (A53121)
The following articles have been revised and will become effective June 6, 2022:
Billing and Coding: Approved Drugs and Biologicals; Includes Cancer Chemotherapeutic Agents (A53049)
Billing and Coding: Complex Drug Administration Coding (A59073)
Billing and Coding: Surgical Treatment of Nails (A52998)
Self-Administered Drug Exclusion List (A53127)
The comment period is now closed for the following Proposed LCDs. Comments received will be reviewed by our Contractor Medical Directors. The Response to Comments Articles and finalized Billing and Coding Articles will be related to the final LCDs when they are posted for notice.
Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs) (DL38229)
Skin Substitutes for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers (DL35041)
The following billing and coding article has been retired:
Billing and Coding: Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Physician Requirements (A55758)
The following LCDs have been revised:
Ambulance Services (Ground Ambulance) (L35162)
Cosmetic and Reconstructive Surgery (L35090)
Implantable Continuous Glucose Monitors (I-CGM) (L38617)
As a reminder, the comment period for the following Proposed Local Coverage Determinations (LCDs) is currently open and will close on May 28, 2022. Please consider including literature/evidence in support of your request with your comments. We encourage you to submit your comments as soon as possible.
Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs) (DL38229)
Skin Substitutes for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers (DL35041)
Submit Comments
The following billing and coding articles have been revised:
Billing and Coding: Diagnostic Abdominal Aortography and Renal Angiography (A56682)
Billing and Coding: eVox® System and Other Electroencephalograph Testing for Memory Loss (A56440)
Billing and Coding: Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs) (A56642)
Billing and Coding: Information Regarding Uses, Including Off-Label Uses, of Anti-Vascular Endothelial Growth Factor (anti-VEGF), for The Treatment of Ophthalmological Diseases (A53121)
Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs (A56776)
Billing and Coding: Molecular Pathology and Genetic Testing (A58917)
Billing and Coding: Respiratory Pathogen Panel Testing (A58575)
Please refer to the sticky note on the following for revisions:
Self-Administered Drug Exclusion List (effective 6/6/2022) (A53127)
The following LCD has been revised:
Therapy and Rehabilitation Services (PT, OT) (L35036)
The following LCD has been revised:
Implantable Continuous Glucose Monitors (I-CGM) (L38617)
The following billing and coding article has been added and will become effective June 6, 2022:
Billing and Coding: Complex Drug Administration Coding (A59073)
The following Local Coverage Article has been revised effective for dates of service on and after June 6, 2022:
Self-Administered Drug Exclusion List (A53127)
The following Proposed Local Coverage Determinations (LCDs) have been posted for comments. The comment period will end on May 28, 2022; however, you are encouraged to submit your comments as soon as possible.
Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs) (DL38229)
Skin Substitutes for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers (DL35041)
Submit Comments
The following Draft Billing and Coding Articles are related to the above Proposed LCDS.
Billing and Coding: Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs) (DA56642)
Billing and Coding: Skin Substitutes for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers (DA54117)
The following billing and coding article has been revised:
Billing and Coding: Removal of Benign Skin Lesions (A57113)
The following billing and coding articles have been revised:
Billing and Coding: Approved Drugs and Biologicals; Includes Cancer Chemotherapeutic Agents (A53049)
Billing and Coding: Diagnostic Abdominal Aortography and Renal Angiography (A56682)
Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs (A56776)
Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions (A53134)
The following billing and coding article has been retired:
Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Oncologic Conditions (A53132)
The following billing and coding articles have been revised:
Billing and Coding: Information Regarding Uses, Including Off-Label Uses, of Anti-Vascular Endothelial Growth Factor (anti-VEGF) for The Treatment of Ophthalmological Diseases (A53121)
Billing and Coding: Rezum® Procedure (A55352)
The following billing and coding article has been revised:
Billing and Coding: Epidural Steroid Injections for Pain Management (A56681)
The following billing and coding articles have been revised:
Billing and Coding: Allergy Testing (A56558)
Billing and Coding: Cardiology Non-emergent Outpatient Stress Testing (A56423)
Billing and Coding: Diagnostic Abdominal Aortography and Renal Angiography (A56682)
Billing and Coding: Hydration Therapy (A56634)
The following billing and coding articles have been revised:
Billing and Coding: Botulinum Toxins (A58423)
Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Oncologic Conditions (A53132)
Billing and Coding: Platelet Rich Plasma (A58808)
The following Local Coverage Determinations (LCDs) which were posted for notice on December 16, 2021 are now effective. The related billing and coding articles for these LCDs are also now effective:
Genetic Testing for Cardiovascular Disease (L39082)
Billing and Coding: Genetic Testing for Cardiovascular Disease (A58795)
Surgical Treatment of Nails (L34887)
Billing and Coding: Surgical Treatment of Nails (A52998)
The following billing and coding articles have been revised:
Billing and Coding: Biomarkers for Oncology (A52986)
Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Oncologic Conditions (A53132)
Billing and Coding: Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF) (A57752)
The following articles have been revised to reflect the 2022 Annual CPT/HCPCS Code updates effective for dates of service on and after January 1, 2022:
Billing and Coding: Acute Care: Inpatient, Observation and Treatment Room Services (A52985)
Billing and Coding: Allergy Testing (A56558)
Billing and Coding: Autonomic Function Tests (A54954)
Billing and Coding: Biomarkers for Oncology (A52986)
Billing and Coding: Colon Capsule Endoscopy (CCE) (A58414)
Billing and Coding: Endovenous Stenting (A56414)
Billing and Coding: Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea (A56938)
Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A53252)
Billing and Coding: Micro-Invasive Glaucoma Surgery (MIGS) (A56633)
Billing and Coding: Molecular Pathology and Genetic Testing (A58917)
Billing and Coding: Monitored Anesthesia Care (A57361)
Billing and Coding: Pharmacogenomics Testing (A58801)
Billing and Coding: Respiratory Pathogen Panel Testing (A58575)
Billing and Coding: Vestibular and Audiologic Function Studies (A57434)
Billing and Coding: Wireless Capsule Endoscopy (A57753)
The following LCD has been revised:
Epidural Steroid Injections for Pain Management (L36920)
The following article has been retired:
Billing and Coding: Isolated Ultrafiltration for Management of Fluid Overload in Cardiac Disease (A53126)
The following billing and coding article has been revised:
Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Oncologic Conditions (A53132)
The following billing and coding article has been revised:
Billing and Coding: Molecular Pathology and Genetic Testing (A58917)
The Novitas Solutions’ Medical Policy team has evaluated all active Local Coverage Articles for any impact in response to the 2022 Annual HCPCS/CPT Code Update. The following is a list of the impacted Articles. The revised Articles will be published to the Medicare Coverage Database and on our Website in January. Please continue to watch our website for updates.
Billing and Coding: Acute Care: Inpatient, Observation and Treatment Room Services (A52985)
Billing and Coding: Allergy Testing (A56558)
Billing and Coding: Autonomic Function Tests (A54954)
Billing and Coding: Biomarkers for Oncology (A52986)
Billing and Coding: Colon Capsule Endoscopy (CCE) (A58414)
Billing and Coding: Endovenous Stenting (A56414)
Billing and Coding: Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea (A56938)
Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A53252)
Billing and Coding: Micro-Invasive Glaucoma Surgery (MIGS) (A56633)
Billing and Coding: Molecular Pathology and Genetic Testing (A58917)
Billing and Coding: Monitored Anesthesia Care (A57361)
Billing and Coding: Pharmacogenomics Testing (A58801)
Billing and Coding: Respiratory Pathogen Panel Testing (A58575)
Billing and Coding: Vestibular and Audiologic Function Studies (A57434)
Billing and Coding: Wireless Capsule Endoscopy (A57753)
The following Local Coverage Determinations (LCDs) posted for comment on July 29, 2021 have been posted for notice. The LCDs and related Billing and Coding Articles will become effective January 30, 2022:
Genetic Testing for Cardiovascular Disease (L39082)
Billing and Coding: Genetic Testing for Cardiovascular Disease (A58795)
Surgical Treatment of Nails (L34887)
Billing and Coding: Surgical Treatment of Nails (A52998)
The following Response to Comments Articles contain summaries of all comments received and Novitas’ responses:
Response to Comments: Genetic Testing for Cardiovascular Disease (A58955)
Response to Comments: Surgical Treatment of Nails (A58961)
The following LCD has been revised:
Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI) (L35038)
The following Local Coverage Determination (LCDs) which were posted for notice on October 28, 2021 are now effective. The related billing and coding articles for these LCDs are also now effective:
Epidural Steroid Injections for Pain Management (L36920)
Billing and Coding: Epidural Steroid Injections for Pain Management (A56681)
Pharmacogenomics Testing (L39063)
Billing and Coding: Pharmacogenomics Testing (A58801)
Platelet Rich Plasma (L39068)
Billing and Coding: Platelet Rich Plasma (A58808)
The following billing and coding article has been revised:
Billing and Coding: Removal of Benign Skin Lesions (A57113)
The following LCD has been revised and will become effective December 12, 2021:
Biomarkers Overview (L35062)
The following billing and coding articles have been revised and will become effective December 12, 2021:
Billing and Coding: Biomarkers for Oncology (A52986)
Billing and Coding: Biomarkers Overview (A56541)
Billing and Coding: Epidural Steroid Injections for Pain Management (A56681)
Billing and Coding: Pharmacogenomics Testing (A58801)
The following billing and coding article has been revised:
Billing and Coding: Non-Coronary Vascular Stents (A56365)
The following LCDs have been revised:
Non-Coronary Vascular Stents (L35084)
Trigger Point Injections (L35010)
The following Billing and Coding Articles have been revised:
Billing and Coding: Allergy Testing (A56558)
Billing and Coding: Non-Coronary Vascular Stents (A56365)
The following billing and coding articles have been revised:
Billing and Coding: Diagnostic Colonoscopy (A58428)
Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A53252)
The following billing and coding article has been revised and will become effective on December 12, 2021:
Billing and Coding: Platelet Rich Plasma (A58808)
The following billing and coding article is now effective:
Billing and Coding: Molecular Pathology and Genetic Testing (A58917)
The following Billing and Coding article has been revised and will become effective November 8, 2021:
Billing and Coding: Molecular Pathology and Genetic Testing (A58917)
The following Local Coverage Determinations (LCDs) posted for comment on June 10, 2021 have been posted for notice. The LCDs and related Billing and Coding Articles will become effective December 12, 2021:
Epidural Steroid Injections for Pain Management (L36920)
Billing and Coding: Epidural Steroid Injections for Pain Management (A56681)
Pharmacogenomics Testing (L39063)
Billing and Coding: Pharmacogenomics Testing (A58801)
Platelet Rich Plasma (L39068)
Billing and Coding: Platelet Rich Plasma (A58808)
The following Response to Comments Articles contain summaries of all comments received and Novitas’ responses:
Response to Comments: Epidural Steroid Injections for Pain Management (A58926)
Response to Comments: Pharmacogenomics Testing (A58929)
Response to Comments: Platelet Rich Plasma (A58923)
The following Billing and Coding Articles have been revised:
Billing and Coding: Blepharoplasty, Blepharoptosis Repair and Surgical Procedures of the Brow (A57618)
Billing and Coding: Diagnostic Abdominal Aortography and Renal Angiography (A56682)
Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (A57600)
The following Billing and Coding Articles have been revised:
Billing and Coding: Allergy Testing (A56558)
Billing and Coding: Botulinum Toxins (A58423)
The following Local Coverage Article has been revised:
Self-Administered Drug Exclusion List: (A53127)
The following Billing and Coding Articles have been revised to reflect the Annual ICD-10 Code Updates effective for dates of service on and after October 1, 2021.
Billing and Coding: Ambulance Services (Ground Ambulance) (A54574)
Billing and Coding: Assays for Vitamins and Metabolic Function (A56416)
Billing and Coding: Bariatric Surgical Management of Morbid Obesity (A56422)
Billing and Coding: Barium Swallow Studies, Modified (A56589)
Billing and Coding: Biomarkers for Oncology (A52986)
Billing and Coding: BRCA1 and BRCA2 Genetic Testing (A56542)
Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing (A56645)
Billing and Coding: Flow Cytometry (A56676)
Billing and Coding: Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea (A56938)
Billing and Coding: Intensity Modulated Radiation Therapy (IMRT) (A56725)
Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs (A56776)
Billing and Coding: Monitored Anesthesia Care (A57361)
Billing and Coding: Nerve Conduction Studies and Electromyography (A54095)
Billing and Coding: Oximetry Services (A57205)
Billing and Coding: Psychiatric Codes (A57130)
Billing and Coding: Pulmonary Function Testing (A57320)
Billing and Coding: Routine Foot Care (A52996)
Billing and Coding: Trigger Point Injections (A57751)
Billing and Coding: Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic) (A57414)
Billing and Coding: Vestibular and Audiologic Function Studies (A57434)
In addition to the ICD-10-CM revisions, the following billing and coding article has been revised in response to an inquiry.
Billing and Coding: Respiratory Pathogen Panel Testing (A58575)
The following Billing and Coding Article has been revised:
Billing and Coding: Spinal Cord Stimulation (Dorsal Column Stimulation) (A57023)
The following Billing and Coding Article has been added and will become effective November 8, 2021:
Billing and Coding: Molecular Pathology and Genetic Testing (A58917)
The following Billing and Coding article has been revised:
Billing and Coding: Biomarkers for Oncology (A52986)
The Novitas Solutions medical policy team has evaluated all active Local Coverage Determinations (LCDs) and Local Coverage Articles for any impact in response to the 2022 Annual ICD-10 Code Update. The following is a list of the impacted articles. The revised articles will be published to the Medicare Coverage Database and on the Novitas Website in the middle of October. Please continue to watch our website for updates.
Billing and Coding: Ambulance Services (Ground Ambulance) (A54574)
Billing and Coding: Assays for Vitamins and Metabolic Function (A56416)
Billing and Coding: Bariatric Surgical Management of Morbid Obesity (A56422)
Billing and Coding: Barium Swallow Studies, Modified (A56589)
Billing and Coding: Biomarkers for Oncology (A52986)
Billing and Coding: BRCA1 and BRCA2 Genetic Testing (A56542)
Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing (A56645)
Billing and Coding: Flow Cytometry (A56676)
Billing and Coding: Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea (A56938)
Billing and Coding: Intensity Modulated Radiation Therapy (IMRT) (A56725)
Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs (A56776)
Billing and Coding: Monitored Anesthesia Care (A57631)
Billing and Coding: Nerve Conduction Studies and Electromyography (A54095)
Billing and Coding: Oximetry Services (A57205)
Billing and Coding: Psychiatric Codes (A57130)
Billing and Coding: Pulmonary Function Testing (A57320)
Billing and Coding: Respiratory Pathogen Panel Testing (A58575)
Billing and Coding: Routine Foot Care (A52996)
Billing and Coding: Trigger Point Injections (A57751)
Billing and Coding: Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic) (A57414)
Billing and Coding: Vestibular and Audiologic Function Studies (A57434)
The comment period is now closed for the following Proposed LCDs. Comments received will be reviewed by our Contractor Medical Directors. The Response to Comments Articles and finalized Billing and Coding Articles will be related to the final LCDs when they are posted for notice.
Genetic Testing for Cardiovascular Disease (DL39082)
Surgical Treatment of Nails (DL34887)
The following LCD has been revised:
Cataract Extraction (including Complex Cataract Surgery) (L35091)
The following Billing and Coding Article has been revised:
Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A53252)
As a reminder, the comment period for the following Proposed Local Coverage Determinations (LCDs) is currently open and will close on September 11, 2021. We encourage you to submit your comments as soon as possible.
Genetic Testing for Cardiovascular Disease (DL39082)
Surgical Treatment of Nails (DL34887)
Submit Comments
The following Billing and Coding Articles have been revised:
Billing and Coding: Cardiology Non-emergent Outpatient Stress Testing (A56423)
Billing and Coding: Diagnostic Colonoscopy (A58428)
Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A53252)
Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Oncologic Conditions (A53132)
The following Billing and Coding Article has been added and will become effective September 13, 2021:
Billing and Coding: Tetanus Immunization (A58872)
The following Billing and Coding Article has been retired:
Billing and Coding: Implantable Automatic Defibrillators (A56355)
The following Proposed Local Coverage Determinations (LCDs) have been posted for comments. The comment period will end on September 11, 2021; however, you are encouraged to submit your comments as soon as possible.
Genetic Testing for Cardiovascular Disease (DL39082)
Surgical Treatment of Nails (DL34887)
The following Draft Billing and Coding Articles are related to the above Proposed LCDs.
Billing and Coding: Genetic Testing for Cardiovascular Disease (DA58795)
Billing and Coding: Surgical Treatment of Nails (DA52998)
The comment period is now closed for the following Proposed Local Coverage Determinations. Comments received will be reviewed by our Contractor Medical Directors. The Response to Comments Article and finalized Billing and Coding Article will be related to the final LCD when it is posted for notice.
Epidural Procedures for Pain Management (DL36920)
Pharmacogenomics Testing (DL39063)
Platelet Rich Plasma (DL39068)
As a reminder, the comment period for the following Proposed Local Coverage Determinations (LCDs) is currently open and will close on July 24, 2021. We encourage you to submit your comments as soon as possible.
Epidural Procedures for Pain Management (DL36920)
Pharmacogenomics Testing (DL39063)
Platelet Rich Plasma (DL39068)
The following LCDs and related billing and coding articles, as applicable, are now effective:
Allergen Immunotherapy (L36240)
Billing and Coding: Allergen Immunotherapy (A56538)
Allergy Testing (L36241)
Billing and Coding: Allergy Testing (A56558)
Cataract Extraction (including Complex Cataract Surgery (L35091)
Billing and Coding: Cataract Extraction (including Complex Cataract Surgery) (A56615)
Cosmetic and Reconstructive Surgery (L35090)
Billing and Coding: Cosmetic and Reconstructive Surgery (A56587)
Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF) (L35130)
Respiratory Pathogen Panel Testing (L38916)
Billing and Coding: Respiratory Pathogen Panel Testing (A58575)
Search Enhancement
We are pleased to announce that a search enhancement has been added to the Local Coverage Determination (LCD) and Article Indexes (Active, Proposed and Retired). A new search box has been added above each LCD/Article Index table. This convenient tool will look for a direct word match within the title, for the LCD or Article number, or for a CPT/HCPCS code listed in the index. You can find our new search tool on the website here. Our Medical Policy Search Tool continues to be available for more advanced searches of LCDs and Articles.
The following LCDs have been retired:
Co-Management of Surgical Procedures (L34862)
Prostate Mapping Biopsy (L35009)
The following billing and coding articles have been revised:
Billing and Coding: Diagnostic Abdominal Aortography and Renal Angiography (A56682)
Billing and Coding: Diagnostic Colonoscopy (A58428)
Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Oncologic Conditions (A53132)
The following Billing and Coding articles have been retired:
Billing and Coding: Co-Management of Surgical Procedures (A52989)
Billing and Coding: Prostate Mapping Biopsy (A56966)
As a reminder, the comment period for the following Proposed Local Coverage Determinations (LCDs) is currently open and will close on July 24, 2021. We encourage you to submit your comments as soon as possible.
Epidural Procedures for Pain Management (DL36920)
Pharmacogenomics Testing (DL39063)
Platelet Rich Plasma (DL39068)
The following Proposed Local Coverage Determinations (LCDs) have been posted for comments. The comment period will end on July 24, 2021; however, you are encouraged to submit your comments as soon as possible.
Epidural Procedures for Pain Management (DL36920)
Pharmacogenomics Testing (DL39063)
Platelet Rich Plasma (DL39068)
The following Draft Billing and Coding Articles are related to the above Proposed LCDs.
Billing and Coding: Epidural Procedures for Pain Management (DA56681)
Billing and Coding: Pharmacogenomics Testing (DA58801)
Billing and Coding: Platelet Rich Plasma (DA58808)
The following LCD has been revised:
Facet Joint Interventions for Pain Management (L34892)
The following Billing and Coding Articles have been revised:
Billing and Coding: Botulinum Toxins (A58423)
Billing and Coding: Diagnostic Colonoscopy (A58428)
Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A53252)
The following Local Coverage Determinations (LCDs) posted for comment on January 14, 2021 have been posted for notice. The LCDs and related Billing and Coding Articles, as applicable, will become effective July 11, 2021:
Allergen Immunotherapy (L36240)
Billing and Coding: Allergen Immunotherapy (A56538)
Allergy Testing (L36241)
Billing and Coding: Allergy Testing (A56558)
Cataract Extraction (including Complex Cataract Surgery (L35091)
Billing and Coding: Cataract Extraction (including Complex Cataract Surgery) (A56615)
Cosmetic and Reconstructive Surgery (L35090)
Billing and Coding: Cosmetic and Reconstructive Surgery (A56587)
Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF) (L35130)
Respiratory Pathogen Panel Testing (L38916)
Billing and Coding: Respiratory Pathogen Panel Testing (A58575)
The following Response to Comments Articles contain summaries of all comments received and Novitas’ responses:
Response to Comments: Allergen Immunotherapy (A58754)
Response to Comments: Allergy Testing (A58750)
Response to Comments: Cataract Extraction (including Complex Cataract Surgery) (A58764)
Response to Comments: Cosmetic and Reconstructive Surgery (A58771)
Response to Comments: Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF) (A58685)
Response to Comments: Respiratory Pathogen Panel Testing (A58769)
The following Billing and Coding Articles have been revised:
Billing and Coding: Blepharoplasty, Blepharoptosis Repair and Surgical Procedures of the Brow (A57618)
Billing and Coding: Facet Joint Interventions for Pain Management (A56670)
The following LCDs have been revised:
Bariatric Surgical Management of Morbid Obesity (L35022)
Hydration Therapy (L34960)
Independent Diagnostic Testing Facility (IDTF) (L35448)
The following Billing and Coding Articles have been revised:
Billing and Coding: Approved Drugs and Biologicals; Includes Cancer Chemotherapeutic Agents (A53049)
Billing and Coding: Hemophilia Factor Products (A56433)
Billing and Coding: Non-Coronary Vascular Stents (A56365)
Billing and Coding: Non-Invasive Peripheral Venous Studies (A52993)
The following LCDs and related billing and coding articles are now effective:
Cardiology Non-emergent Outpatient Stress Testing (L35083)
Billing and Coding: Cardiology Non-emergent Outpatient Stress Testing (A56423)
Facet Joint Interventions for Pain Management (L34892)
Billing and Coding: Facet Joint Interventions for Pain Management (A56670)
The following Billing and Coding Article is now effective:
Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions (A53134)
The following Future Local Coverage Determination (LCD) and related Billing and Coding Article, which become effective April 25, 2021, have been revised:
Facet Joint Interventions for Pain Management (L34892)
Billing and Coding: Facet Joint Interventions for Pain Management (A56670)
The following Billing and Coding Article has been revised and will become effective April 25, 2021:
Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions (A53134)
The following Billing and Coding Articles have been revised:
Billing and Coding: Biomarkers for Oncology (A52986)
Billing and Coding: Hyaluronan Acid Therapies for Osteoarthritis of the Knee (A55036)
Billing and Coding: Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic) (A57414)
The following Billing and Coding Article has been revised:
Billing and Coding: Hemophilia Factor Products (A56433)
The following Local Coverage Article which was revised and posted on February 18, 2021 is now effective:
Self-Administered Drug Exclusion List (A53127)
The following Billing and Coding Article has been revised:
Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A53252)
The following Local Coverage Determination (LCD) which was posted for notice on February 11, 2021 is now effective. The related billing and coding article for this LCD is also now effective.
Colon Capsule Endoscopy (CCE) (L38807)
Billing and Coding: Colon Capsule Endoscopy (CCE) (A58414)
The following Local Coverage Determination (LCDs) which were posted for notice on February 4, 2021 are now effective. The related billing and coding articles for these LCDs are also now effective:
Blepharoplasty, Blepharoptosis Repair and Surgical Procedures of the Brow (L35004)
Billing and Coding: Blepharoplasty, Blepharoptosis Repair and Surgical Procedures of the Brow (A57618)
Botulinum Toxins (L38809)
Billing and Coding: Botulinum Toxins (A58423)
Diagnostic Colonoscopy (L38812)
Billing and Coding: Diagnostic Colonoscopy (A58428)
The following Local Coverage Determinations (LCDs) posted for comment on October 29, 2020 have been posted for notice. The LCDs and related Billing and Coding Articles will become effective April 25, 2021:
Cardiology Non-emergent Outpatient Stress Testing (L35083)
Billing and Coding: Cardiology Non-emergent Outpatient Stress Testing (A56423)
Facet Joint Interventions for Pain Management (L34892)
Billing and Coding: Facet Joint Interventions for Pain Management (A56670)
The following Response to Comments Articles contain summaries of all comments received and Novitas’ responses:
Response to Comments: Cardiology Non-emergent Outpatient Stress Testing (A58661)
Response to Comments: Facet Joint Interventions for Pain Management (A58667)
The following Billing and Coding articles have been revised:
Billing and Coding: Hydration Therapy (A56634)
Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A53252)
Billing and Coding: Treatment of Chronic Venous Insufficiency of the Lower Extremities (A55229)
The comment period is now closed for the following Proposed Local Coverage Determinations. Comments received will be reviewed by our Contractor Medical Directors. The Response to Comments Article and finalized Billing and Coding Article will be related to the final LCD when it is posted for notice.
Allergen Immunotherapy (DL36240)
Allergy Testing (DL36241)
Cataract Extraction (including Complex Cataract Surgery) (DL35091)
Cosmetic and Reconstructive Surgery (DL35090)
Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF) (DL35130)
Respiratory Pathogen Panel Testing (DL38916)
The following LCDs have been revised:
Intensity Modulated Radiation Therapy (IMRT) (L36711)
Outpatient Sleep Studies (L35050)
The following Billing and Coding Articles have been revised:
Billing and Coding: Non-Invasive Peripheral Venous Studies (A52993)
Billing and Coding: Non-Vascular Extremity Ultrasound (A55037)
The following Billing and Coding Article has been revised:
Billing and Coding: Nerve Conduction Studies and Electromyography (A54095)
The following Local Coverage Article has been revised effective for dates of service on and after April 5, 2021:
Self-Administered Drug Exclusion List (A53127)
As a reminder, the comment period for the following Proposed Local Coverage Determinations (LCDs) is currently open and will close on February 27, 2021. We encourage you to submit your comments as soon as possible.
Allergen Immunotherapy (DL36240)
Allergy Testing (DL36241)
Cataract Extraction (including Complex Cataract Surgery) (DL35091)
Cosmetic and Reconstructive Surgery (DL35090)
Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF) (DL35130)
Respiratory Pathogen Panel Testing (DL38916)
The following LCD which was posted for comment on August 27, 2020, has been posted for notice. The LCD and related Billing and Coding Article will become effective March 28, 2021:
Colon Capsule Endoscopy (CCE) (L38807)
Billing and Coding: Colon Capsule Endoscopy (CCE) (A58414)
The following Response to Comments Article contains summaries of all comments received and Novitas’ responses:
Response to Comments: Colon Capsule Endoscopy (A58606)
The following articles have been revised to reflect the 2021 Annual CPT/HCPCS Code updates effective for dates of service on and after January 1, 2021:
Billing and Coding: Acute Care: Inpatient, Observation and Treatment Room Services (A52985)
Billing and Coding: Biomarkers for Oncology (A52986)
Billing and Coding: Cosmetic and Reconstructive Surgery (A56587)
Billing and Coding: Epidural Injections for Pain Management (A56681)
Billing and Coding: eVox® System and Other Electroencephalograph Testing for Memory Loss (A56440)
Billing and Coding: Hemophilia Factor Products (A56433)
Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A53252)
Billing and Coding: Multiple Imaging in Oncology (A56848)
Billing and Coding: Neurophysiology Evoked Potentials (NEPs) (A56773)
Billing and Coding: Pulmonary Function Testing (A57320)
Billing and Coding: Vestibular and Audiologic Function Studies (A57434)
The following Local Coverage Determinations (LCDs) posted for comment on September 24, 2020 have been posted for notice. The LCDs and related Billing and Coding Articles will become effective March 21, 2021:
Blepharoplasty, Blepharoptosis Repair and Surgical Procedures of the Brow (L35004)
Billing and Coding: Blepharoplasty, Blepharoptosis Repair and Surgical Procedures of the Brow (A57618)
Botulinum Toxins (L38809)
Billing and Coding: Botulinum Toxins (A58423)
Diagnostic Colonoscopy (L38812)
Billing and Coding: Diagnostic Colonoscopy (A58428)
The following Response to Comments Articles contain summaries of all comments received and Novitas’ responses:
Response to Comments: Blepharoplasty, Blepharoptosis Repair and Surgical Procedures of the Brow (A58586)
Response to Comments: Botulinum Toxins (A58584)
Response to Comments: Diagnostic Colonoscopy (A58612)
The following Billing and Coding article has been revised:
Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders (A54111)
The following Proposed Local Coverage Determinations (LCDs) have been posted for comments. The comment period will end on February 27, 2021; however, you are encouraged to submit your comments as soon as possible.
Allergen Immunotherapy (DL36240)
Allergy Testing (DL36241)
Cataract Extraction (including Complex Cataract Surgery) (DL35091)
Cosmetic and Reconstructive Surgery (DL35090)
Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF) (DL35130)
Respiratory Pathogen Panel Testing (DL38916)
The following Draft Billing and Coding Articles are related to the above Proposed LCDs.
Billing and Coding: Allergen Immunotherapy (DA56538)
Billing and Coding: Allergy Testing (DA56558)
Billing and Coding: Cataract Extraction (including Complex Cataract Surgery) (DA56615)
Billing and Coding: Cosmetic and Reconstructive Surgery (DA56587)
Billing and Coding: Respiratory Pathogen Panel Testing (DA58575)
The following Billing and Coding Article has been revised:
Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (A57600)
The following Local Coverage Article has been revised:
Self-Administered Drug Exclusion List (A53127)
Due to extenuating circumstances, the Annual HCPCS/CPT Code Update has been delayed. The following is a preliminary list of Billing and Coding Articles that will be revised in response to the update. Due to the delay, it is anticipated that the revisions will be published to the Medicare Coverage Database (MCD) and our website in early February. Please continue to watch our website for further updates.
Billing and Coding: Acute Care: Inpatient, Observation and Treatment Room Services (A52985)
Billing and Coding: Biomarkers for Oncology (A52986)
Billing and Coding: Cosmetic and Reconstructive Surgery (A56587)
Billing and Coding: eVox® System and Other Electroencephalograph Testing for Memory Loss (A56440)
Billing and Coding: Hemophilia Factor Products (A56433)
Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A53252)
Billing and Coding: Neurophysiology Evoked Potentials (NEPs) (A56773)
Billing and Coding: Vestibular and Audiologic Function Studies (A57434)
The following Local Coverage Determinations (LCDs) are now effective:
Endovenous Stenting (L37893)
Transurethral Waterjet Ablation of the Prostate (L38712)
Treatment of Chronic Venous Insufficiency of the Lower Extremities (L34924)
The following Billing and Coding Articles are now effective:
Billing and Coding: Transurethral Waterjet Ablation of the Prostate (A58243)
Billing and Coding: Treatment of Chronic Venous Insufficiency of the Lower Extremities (A55229)
The following Local Coverage Determination (LCD) has been revised:
Non-Invasive Peripheral Venous Studies (L35451)
The following Billing and Coding Article has been revised:
Billing and Coding: Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Physician Requirements (A55758)
The following Local Coverage Determination (LCD) which was posted for notice on October 29, 2020 is now effective. The companion article for this LCD is also now effective:
Biomarkers for Oncology (L35396)
Billing and Coding: Biomarkers for Oncology (A52986)
The comment period is now closed for the following Proposed Local Coverage Determinations. Comments received will be reviewed by our Contractor Medical Directors. The Response to Comments Article and finalized Billing and Coding Article will be related to the final LCD when it is posted for notice.
Cardiology Non-emergent Outpatient Stress Testing (DL35083)
Facet Joint Interventions for Pain Management (DL34892)
The following Local Coverage Determination and related Billing and Coding Article have been revised:
BRCA1 and BRCA2 Genetic Testing (L36715)
Billing and Coding: BRCA1 and BRCA2 Genetic Testing (A56542)
The following Billing and Coding Article has been revised:
Billing and Coding: Hydration Therapy (A56634)
As a reminder, the comment period for the following Proposed Local Coverage Determinations (LCDs) is currently open and will close on December 12, 2020. We encourage you to submit your comments as soon as possible.
Cardiology Non-emergent Outpatient Stress Testing (DL35083)
Facet Joint Interventions for Pain Management (DL34892)
The following Local Coverage Determinations (LCDs) posted for comment on June 25, 2020 have been posted for notice. The LCDs and related Billing and Coding Articles will become effective December 27, 2020:
Transurethral Waterjet Ablation of the Prostate (L38712)
Billing and Coding: Transurethral Waterjet Ablation of the Prostate (A58243)
Treatment of Chronic Venous Insufficiency of the Lower Extremities (L34924)
Billing and Coding: Treatment of Chronic Venous Insufficiency of the Lower Extremities (A55229)
The following LCD posted for comment on June 25, 2020 has been posted for notice and will become effective December 27, 2020.
Endovenous Stenting (L37893)
The following Response to Comments Articles contain summaries of all comments received and Novitas’ responses:
Response to Comments: Endovenous Stenting (A58394)
Response to Comments: Transurethral Waterjet Ablation of the Prostate (A58377)
Response to Comments: Treatment of Chronic Venous Insufficiency of the Lower Extremities (A58378)
The following Billing and Coding Article has been revised:
Billing and Coding: Thrombolytic Agents (A55237)
The following Billing and Coding Article has been added:
Billing and Coding: Urodynamic Services - Non-invasive (A58541)
The comment period is now closed for the following Proposed Local Coverage Determinations (LCDs). Comments received will be reviewed by our Contractor Medical Directors. The Response to Comments Articles and finalized Billing and Coding Articles will be published and related to the final LCDs when they are posted for notice.
Blepharoplasty and Surgical Procedures of the Brow (DL35004)
Botulinum Toxins (DL38809)
Diagnostic Colonoscopy (DL38812)
The comment period remains open until December 12, 2020 for the following proposed LCDs.
Cardiology Non-emergent Outpatient Stress Testing (DL35083)
Facet Joint Interventions for Pain Management (DL34892)
The following Proposed Local Coverage Determinations (LCDs) have been posted for comments. The comment period will end on December 12, 2020; however, you are encouraged to submit your comments as soon as possible.
Cardiology Non-emergent Outpatient Stress Testing (DL35083)
Facet Joint Interventions for Pain Management (DL34892)
The following Draft Billing and Coding Articles are related to the above Proposed LCDs.
Billing and Coding: Cardiology Non-emergent Outpatient Stress Testing (DA56423)
Billing and Coding: Facet Joint Interventions for Pain Management (DA56670)
The following Local Coverage Determination (LCD) posted for comment on October 31, 2019 has been posted for notice. The LCD and related Billing and Coding Article will become effective December 13, 2020:
Biomarkers for Oncology (L35396)
Billing and Coding: Biomarkers for Oncology (A52986)
The following Response to Comments Article contains summaries of all comments received and Novitas’ responses:
Response to Comments: Biomarkers for Oncology (A58529)
As a reminder, the comment period for the following Proposed Local Coverage Determinations (LCDs) is currently open and will close on November 7, 2020. We encourage you to submit your comments as soon as possible.
Blepharoplasty and Surgical Procedures of the Brow (DL35004)
Botulinum Toxins (DL38809)
Diagnostic Colonoscopy (DL38812)
Submit Comments
The following Billing and Coding Article has been revised:
Billing and Coding: Psychiatric Codes (A57130)
The following Local Coverage Determination (LCD) which was posted for notice on August 27, 2020 is now effective. The companion article for this LCD is also now effective:
Implantable Continuous Glucose Monitors (I-CGM) (L38617)
Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM) (A58110)
The comment period is now closed for the following Proposed Local Coverage Determination. Comments received will be reviewed by our Contractor Medical Directors. The Response to Comments Article and finalized Billing and Coding Article will be related to the final LCD when it is posted for notice.
Colon Capsule Endoscopy (CCE) (DL38807)
Billing and Coding: Colon Capsule Endoscopy (CCE) (DA58414)
The following Billing and Coding Articles have been revised to reflect the Annual ICD-10 Code Updates effective for dates of service on and after October 1, 2020.
Billing and Coding: Allergen Immunotherapy (A56538)
Billing and Coding: Allergy Testing (A56558)
Billing and Coding: Ambulance Services (Ground Ambulance) (A54574)
Billing and Coding: Assays for Vitamins and Metabolic Function (A56416)
Billing and Coding: Bariatric Surgical Management of Morbid Obesity (A56422)
Billing and Coding: Biomarkers for Oncology (A52986)
Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing (A56645)
Billing and Coding: Epidural Injections for Pain Management (A56681)
Billing and Coding: Flow Cytometry (A56676)
Billing and Coding: Hydration Therapy (A56634)
Billing and Coding: Hypoglossal Nerve Stimulation for Treatment of Obstructive Sleep Apnea (A56938)
Billing and Coding: Intravenous Immune Globulin (IVIG) (A56786)
Billing and Coding: Magnetic Resonance Angiography (MRA) (A56805)
Billing and Coding: Monitored Anesthesia Care (A57361)
Billing and Coding: Nerve Conduction Studies and Electromyography (A54095)
Billing and Coding: Neurophysiology Evoked Potentials (NEPs) (A56773)
Billing and Coding: Oximetry Services (A57205)
Billing and Coding: Psychiatric Codes (A57130)
Billing and Coding: Pulmonary Function Testing (A57320)
Billing and Coding: Routine Foot Care (A52996)
Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (A57600)
Billing and Coding: Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic) (A57414)
The following LCD and related Billing and Coding Article have been retired:
Chiropractic Services (L35424)
Billing and Coding: Chiropractic Services (A52987)
The following Billing and Coding Article that was published on August 27, 2020 is now effective:
Billing and Coding: Chiropractic Services (A58345)
The following Proposed Local Coverage Determinations (LCDs) have been posted for comments. The comment period will end on November 7, 2020; however, you are encouraged to submit your comments as soon as possible.
Blepharoplasty and Surgical Procedures of the Brow (DL35004)
Botulinum Toxins (DL38809)
Diagnostic Colonoscopy (DL38812)
The following Draft Billing and Coding Articles are related to the above Proposed LCDs.
Billing and Coding: Blepharoplasty and Surgical Procedures of the Brow (DA57618)
Billing and Coding: Botulinum Toxins (DA58423)
Billing and Coding: Diagnostic Colonoscopy (DA58428)
The following Billing and Coding article has been revised:
Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A53252)
The following LCD and related Billing and Coding Article have been retired:
Corus® CAD Test (L36713)
Billing and Coding: Corus® CAD Test (A56608)
The following Proposed Local Coverage Determination (LCD) has been posted for comments. The comment period will end on October 10, 2020, however you are encouraged to submit your comments as soon as possible.
Colon Capsule Endoscopy (CCE) (DL38807)
Submit Comments
The following Draft Billing and Coding Article is related to the above Proposed LCD.
Billing and Coding: Colon Capsule Endoscopy (CCE) (DA58414)
The following Local Coverage Determination (LCD) posted for comment on April 30, 2020 has been posted for notice. The LCD and related Billing and Coding Article will become effective October 11, 2020:
Implantable Continuous Glucose Monitors (I-CGM) (L38617)
Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM) (A58110)
The following Response to Comments Article contains summaries of all comments received and Novitas’ responses:
Response to Comments: Implantable Continuous Glucose Monitors (I-CGM) (A58415)
The following Future Billing and Coding Article, which will replace the current Billing and Coding Article: Chiropractic Services (A52987), has been published and will become effective October 01, 2020:
Billing and Coding: Chiropractic Services (A58345)
The following LCDs and related Billing and Coding Articles have been retired:
Hyperbaric Oxygen (HBO) Therapy (L35021)
Billing and Coding: Hyperbaric Oxygen (HBO) Therapy (A56714)
Reflectance Confocal Microscopy (L37375)
Billing and Coding: Reflectance Confocal Microscopy (A56969)
The following Billing and Coding Article has been revised, consistent with CPT guidelines, to clarify that non-graft wound dressings (e.g., gel, powder, ointment, foam, liquid) or injected skin substitutes should not be reported with skin replacement surgery application codes. Claims received on and after August 13, 2020 reporting non-graft wound dressings with a surgery application code will be rejected.
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (A54117)
The following Local Coverage Determinations (LCDs) have been revised:
Cardiac Rhythm Device Evaluation (L34833)
Speech-Language Pathology (SLP) Services: Communication Disorders (L35070)
The following Billing and Coding Articles have been revised:
Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs) (A56642)
Non-Invasive Peripheral Venous Studies (A52993)
The following LCDs and their related Billing and Coding Articles have been retired:
Molecular Diagnostics: Genitourinary Infectious Disease Testing (L35015)
Billing and Coding: Molecular Diagnostics: Genitourinary Infectious Disease Testing (A56791)
Sacral Nerve Stimulation (L35449)
Billing and Coding: Sacral Nerve Stimulation (A57617)
The comment period is now closed for the following Proposed Local Coverage Determinations. Comments received will be reviewed by our Contractor Medical Directors. The Response to Comments Articles and finalized Billing and Coding Articles will be related to the final LCDs when they are posted for notice.
Endovenous Stenting (DL37893)
Transurethral Waterjet Ablation of the Prostate (DL38712)
Treatment of Chronic Venous Insufficiency of the Lower Extremities (DL34924)
The following Billing and Coding articles have been revised to reflect the July 2020 CPT/HCPCS Code Quarterly updates effective for dates of service on and after July 1, 2020:
Billing and Coding: Allergy Testing (A56558)
Billing and Coding: Hemophilia Factor Products (A56433)
Billing and Coding: Hyaluronan Acid Therapies for Osteoarthritis of the Knee (A55036)
Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A53252)
As a reminder, the comment period for the following Proposed Local Coverage Determinations (LCDs) is currently open and will close on August 8, 2020. We encourage you to submit your comments as soon as possible to allow ample time for us to review them thoroughly.
Endovenous Stenting (DL37893)
Transurethral Waterjet Ablation of the Prostate (DL38712)
Treatment of Chronic Venous Insufficiency of the Lower Extremities (DL34924)
Submit Comments
The following Local Coverage Determination (LCD) and its related Billing and Coding Article has been revised:
Trigger Point Injections (L35010)
Billing and Coding: Trigger Point Injections (A57751)
The following LCD has been revised:
Wound Care (L35125)
The following Billing and Coding Article has been revised:
Billing and Coding: Auricular Peripheral Nerve Stimulation (Electro-Acupuncture Device) (A55240)
The following LCDs and related Billing and Coding Articles have been retired:
Nusinersen (Spinraza) (L37682)
Billing and Coding: Nusinersen (Spinraza) (A56860)
Strapping (L36423)
Billing and Coding: Strapping (A56804)
As a reminder, the comment period for the following Proposed Local Coverage Determinations (LCDs) is currently open and will close on August 8, 2020. We encourage you to submit your comments as soon as possible to allow ample time for us to review them thoroughly.
Endovenous Stenting (DL37893)
Transurethral Waterjet Ablation of the Prostate (DL38712)
Treatment of Chronic Venous Insufficiency of the Lower Extremities (DL34924)
Submit Comments
The following Local Coverage Determinations (LCDs) which were posted for notice on May 28, 2020 are now effective. The related Billing and Coding articles for these LCDs are also now effective:
Magnetic-Resonance-Guided Focused Ultrasound Surgery (MRgFUS) for Essential Tremor (L38495)
Billing and Coding: Magnetic-Resonance-Guided Focused Ultrasound Surgery (MRgFUS) for Essential Tremor (A57839)
Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF) (L35130)
Billing and Coding: Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF) (A57752)
The following LCDs and related Billing and Coding Articles have been revised:
Allergy Testing (L36241)
Billing and Coding: Allergy Testing (A56558)
Assays for Vitamins and Metabolic Function (L34914)
Billing and Coding: Assays for Vitamins and Metabolic Function (A56416)
Biomarkers for Oncology (L35396)
Billing and Coding: Biomarkers for Oncology (A52986)
Biomarkers Overview (L35062)
Billing and Coding: Biomarkers Overview (A56541)
Magnetic Resonance Angiography (MRA) (L34865)
Billing and Coding: Magnetic Resonance Angiography (MRA) (A56805)
Pulmonary Function Testing (L35360)
Billing and Coding: Pulmonary Function Testing (A57320)
The following LCDs have been revised:
Epidural Injections for Pain Management (L36920)
Psychiatric Codes (L35101)
The following Billing and Coding Article has been revised:
Billing and Coding: Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (A54117)
The following LCDs and the related Billing and Coding Articles have been retired effective for dates of service on and after July 1, 2020:
In Vitro Chemosensitivity & Chemoresistance Assays (L36634)
Billing and Coding: In Vitro Chemosensitivity & Chemoresistance Assays (A56710)
Microvascular Therapy (L36434)
Billing and Coding: Microvascular Therapy (A54343)
Outpatient Wireless Pulmonary Artery Pressure Monitoring for Heart Failure (L36419)
Billing and Coding: Outpatient Wireless Pulmonary Artery Pressure Monitoring for Heart Failure (A56856)
Services That Are Not Reasonable and Necessary (L35094)
Billing and Coding: Services That Are Not Reasonable and Necessary (A56967)
Speech-Language Pathology (SLP) Services: Dysphagia; Includes VitalStim® Therapy (L34891)
Billing and Coding: Speech-Language Pathology (SLP) Services: Dysphagia; Includes VitalStim® Therapy (A57656)
The following Proposed Local Coverage Determinations (LCDs) have been posted for comments. The comment period will end on August 8, 2020, however you are encouraged to submit your comments as soon as possible to allow ample time for us to review them thoroughly.
Endovenous Stenting (DL37893)
Transurethral Waterjet Ablation of the Prostate (DL38712)
Treatment of Chronic Venous Insufficiency of the Lower Extremities (DL34924)
Submit Comments
The following Draft Billing and Coding Articles are related to the above Proposed LCDs.
Billing and Coding: Treatment of Chronic Insufficiency of the Lower Extremities (DA55229)
Billing and Coding: Transurethral Waterjet Ablation of the Prostate (DA58243)
The following Billing and Coding Article has been revised:
Billing and Coding: Endovenous Stenting (A56414)
The following LCD and related Billing and Coding Article have been retired:
Lacrimal Punctum Plugs (L35095)
Billing and Coding: Lacrimal Punctum Plugs (A56780)
The comment period is now closed for the following Proposed Local Coverage Determination. Comments received will be reviewed by our Contractor Medical Directors. The Response to Comments Article and finalized Billing and Coding Article will be related to the final LCD when it is posted for notice.
Implantable Continuous Glucose Monitors (I-CGM) (DL38617)
As a reminder, the comment period for the following Proposed Local Coverage Determination (LCD) is currently open and will close on June 13, 2020. We encourage you to submit your comments as soon as possible to allow ample time for us to review them thoroughly.
Implantable Continuous Glucose Monitors (I-CGM) (DL38617)
Submit Comments
The following Draft Billing and Coding Article is related to the above Proposed LCD.
Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM) (DA58110)
The following Billing and Coding Article has been added:
Billing and Coding: Screening for Cervical Cancer with Human Papillomavirus (HPV)( A58216)
The following Billing and Coding Article has been revised:
Billing and Coding: Epidural Injections for Pain Management (A56681)
The following Local Coverage Determinations (LCDs) posted for comment on December 26, 2019 have been posted for notice. The LCDs and related Billing and Coding Articles will become effective July 12, 2020:
Magnetic-Resonance-Guided Focused Ultrasound Surgery (MRgFUS) for Essential Tremor (L38495)
Billing and Coding: Magnetic-Resonance-Guided Focused Ultrasound Surgery (MRgFUS) for Essential Tremor (A57839)
Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF) (L35130)
Billing and Coding: Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF) (A57752)
The following Response to Comments Articles contain summaries of all comments received and Novitas’ responses:
Response to Comments: Magnetic-Resonance-Guided-Focused Ultrasound Surgery (MRgFUS) for Essential Tremor (A58049)
Response to Comments: Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF) (A58195)
The following Local Coverage Determination (LCD) posted for notice on April 9, 2020 became effective May 24, 2020. The related Billing and Coding Article also became effective May 24, 2020.
Thrombolytic Agents (L35428)
Billing and Coding: Thrombolytic Agents (A55237)
The following Billing and Coding Article has been revised. It will become effective on May 24, 2020 with its corresponding Local Coverage Determination L35428 which was posted for notice on April 9, 2020.
Billing and Coding: Thrombolytic Agents (A55237)
As a reminder, the comment period for the following Proposed Local Coverage Determination (LCD) is currently open and will close on June 13, 2020. We encourage you to submit your comments as soon as possible to allow ample time for us to review them thoroughly.
Implantable Continuous Glucose Monitors (I-CGM) (DL38617)
Submit Comments
The following Billing and Coding Article has been revised:
Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A53252)
The following Billing and Coding Article has been revised:
Billing and Coding: Services That Are Not Reasonable and Necessary (A56967)
The following Proposed Local Coverage Determination (LCD) has been posted for comments. The comment period will end on June 13, 2020, however you are encouraged to submit your comments as soon as possible to allow ample time for us to review them thoroughly.
Implantable Continuous Glucose Monitors (I-CGM) (DL38617)
Submit Comments
The following Draft Billing and Coding Article is related to the above Proposed LCD.
Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM) (DA58110)
The following LCD has been revised:
Anorectal Manometry, Anal Electromyography, and Biofeedback Training for Perineal Muscles and Anorectal or Urethral Sphincters (L34977)
The following Billing and Coding Articles have been revised:
Billing and Coding: Allergy Testing (A56558)
Billing and Coding: Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (A54117)
Billing and Coding: Micro-Invasive Glaucoma Surgery (MIGS) (A56633)
The following Local Coverage Article has been revised. Due to the current public health emergency the effective date for the addition of Tremfya® (J1628) and Stelara® (J3357) will be deferred until 45 days after the public health emergency ends. Please continue to watch our website for updates.
Self-Administered Drug Exclusion List (A53127)
The following Local Coverage Determination (LCD) and related Billing and Coding Article have been revised:
Services That Are Not Reasonable and Necessary (L35094)
Billing and Coding: Services That Are Not Reasonable and Necessary (A56967)
The following Local Coverage Determination (LCD) posted for comment on October 31, 2019 has been posted for notice. The LCD and related Billing and Coding Article will become effective May 24, 2020:
Thrombolytic Agents (L35428)
Billing and Coding: Thrombolytic Agents (A55237)
The following Response to Comments Article contains summaries of all comments received and Novitas’ responses:
Response to Comments: Thrombolytic Agents (A58012)
The following Billing and Coding Articles have been revised:
Billing and Coding: Implantable Automatic Defibrillators (A56355)
Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions (A53134)
The following Local Coverage Determination (LCD) has been revised:
Ambulance Services (Ground Ambulance) (L35162)
The following Local Coverage Article has been revised and is posted for notice. The article will become effective May 3, 2020:
Self-Administered Drug Exclusion List (A53127)
The following Local Coverage Determination (LCD) which was posted for notice on January 30, 2020 is now effective. The companion article for this LCD is also now effective:
Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea (L38385)
Billing and Coding: Hypoglossal Nerve Stimulation for Treatment of Obstructive Sleep Apnea (A56938)
The following Billing and Coding Article has been revised:
Billing and Coding: Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (A54117)
The following Local Coverage Determinations (LCDs) have been revised:
Hemophilia Factor Products (L35111)
Hyperbaric Oxygen (HBO) Therapy (L35021)
The following Billing and Coding Articles have been revised:
Billing and Coding: Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (A54117)
Billing and Coding: Biomarkers Overview (A56541)
Billing and Coding: Diagnostic Abdominal Aortography and Renal Angiography (A56682)
Billing and Coding: Information Regarding Uses, Including Off-Label Uses, of Anti-Vascular Endothelial Growth Factor (anti-VEGF), for The Treatment of Ophthalmological Diseases (A53121)
Billing and Coding: Intensity Modulated Radiation Therapy (IMRT) (A56725)
Billing and Coding: Intravenous Immune Globulin (IVIG) (A56786)
Billing and Coding: Non-Coronary Vascular Stents (A56365)
The comment period is now closed for the following Proposed Local Coverage Determinations. Comments received will be reviewed by our Contractor Medical Directors. The Response to Comments Articles and finalized Billing and Coding Articles will be related to the final LCDs when they are posted for notice.
Magnetic-Resonance-Guided-Focused Ultrasound Surgery (MRgFUS) for Essential Tremor (DL38495)
Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF) (DL35130)
The comment period will close on February 8, 2020 for the following Proposed Local Coverage Determinations (LCDs):
Magnetic-Resonance-Guided-Focused Ultrasound Surgery (MRgFUS) for Essential Tremor (DL38495)
Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF) (DL35130)
Submit Comments
The following Local Coverage Determination (LCD) posted for comment on August 29, 2019 has been posted for notice. The LCD and related Billing and Coding Article will become effective March 15, 2020:
Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea (L38385)
Billing and Coding: Hypoglossal Nerve Stimulation for Treatment of Obstructive Sleep Apnea (A56938)
The following Response to Comments Article contains summaries of all comments received and Novitas’ responses:
Response to Comments: Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea (A57928)
The following Local Coverage Determination (LCD) has been revised.
Wound Care (L35125)
The following articles have been revised to reflect the Annual CPT/HCPCS Code updates effective for dates of service on and after January 1, 2020:
Billing and Coding: Anorectal Manometry, Anal Electromyography, and Biofeedback Training for Perineal Muscles and Anorectal or Urethral Sphincters (A56530)
Billing and Coding: Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (A54117)
Billing and Coding: Barium Swallow Studies, Modified (A56589)
Billing and Coding: Biomarkers for Oncology (A52986)
Billing and Coding: Cardiac Rhythm Device Evaluation (A56602)
Billing and Coding: Cataract Extraction (including Complex Cataract Surgery) (A56615)
Billing and Coding: Cosmetic and Reconstructive Surgery (A56587)
Billing and Coding: Endovascular Repair of Aortic and/or Iliac Aneurysms (A53124)
Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A53252)
Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions (A53134)
Billing and Coding: Non-Invasive Peripheral Venous Studies (A52993)
Billing and Coding: Pulmonary Function Testing (A57320)
Billing and Coding: Services That Are Not Reasonable and Necessary (A56967)
Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders (A54111)
Billing and Coding: Therapy and Rehabilitation Services (PT, OT) (A57703)
Billing and Coding: Wound Care (A53001)
The following Local Coverage Determinations (LCDs) which were posted for notice on November 14, 2019 are now effective. The related Billing and Coding articles for these LCDs are also now effective:
4Kscore Test Algorithm (L37792)
Billing and Coding: 4Kscore Test Algorithm (A56653)
Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs)( L38229)
Billing and Coding: Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs) (A56642)
Micro-Invasive Glaucoma Surgery (MIGS) (L38223)
Billing and Coding: Micro-Invasive Glaucoma Surgery (MIGS) (A56633)
Please Note: Billing and Coding: 4Kscore Test Algorithm Article (A56281) will be retired effective 12/29/2019. Please refer to A56653 for services on and after 12/30/2019.
The following Local Coverage Determinations (LCDs) has have been posted for comments. The comment period will end on February 8, 2020.
Magnetic-Resonance-Guided-Focused Ultrasound Surgery (MRgFUS) for Essential Tremor (DL38495)
Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF) (DL35130)
Submit Comments
The following Draft Billing and Coding articles are related to the above Proposed LCDs.
Billing and Coding: Magnetic-Resonance-Guided Focused Ultrasound Surgery (MRgFUS) for Essential Tremor (DA57839)
Billing and Coding: Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF) (DA57752)
New Look to Local Coverage Determinations (LCDs) and Billing and Coding Articles
Consistent with the instruction in Change Request (CR) 10901, the Medical Policy Team has been working to relocate all coding information from our Local Coverage Determinations (LCDs) into related Billing and Coding Articles. This project was completed on November 21, 2019. Therefore, you will now find all coding information in Billing and Coding Articles. In order to better assist you in finding the related Billing and Coding Article, a link has been placed at the bottom of the LCDs.
The Novitas Solutions Medical Policy team has evaluated all active Local Coverage Articles for any impact in response to the 2020 Annual HCPCS/CPT Code Update. The following is a list of the impacted Articles. The revised Articles will be published to the Medicare Coverage Database and on our Website in January. Please continue to watch our website for updates.
A56530 - Billing and Coding: Anorectal Manometry, Anal Electromyography, and Biofeedback Training for Perineal Muscles and Anorectal or Urethral Sphincters
A54117 - Billing and Coding: Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds
A56589 - Billing and Coding: Barium Swallow Studies, Modified
A52986 - Billing and Coding: Biomarkers for Oncology
A56602 - Billing and Coding: Cardiac Rhythm Device Evaluation
A56615 - Billing and Coding: Cataract Extraction (including Complex Cataract Surgery)
A56587 - Billing and Coding: Cosmetic and Reconstructive Surgery
A53124 - Billing and Coding: Endovascular Repair of Aortic and/or Iliac Aneurysms
A53252 - Billing and Coding: Independent Diagnostic Testing Facility (IDTF)
A53134 - Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions
A52993 - Billing and Coding: Non-Invasive Peripheral Venous Studies
A57320 - Billing and Coding: Pulmonary Function Testing
A56967 - Billing and Coding: Services That Are Not Reasonable and Necessary
A54111 - Billing and Coding: Speech-Language Pathology (SLP) Services: Communication Disorders
A57703 - Billing and Coding: Therapy and Rehabilitation Services (PT, OT)
A53001 - Billing and Coding: Wound Care
The comment period is now closed for the following Proposed Local Coverage Determinations. Comments received will be reviewed by our Contractor Medical Directors. The Response to Comments Articles and finalized Billing and Coding Articles will be related to the final LCDs when they are posted for notice.
Biomarkers for Oncology (DL35396)
Thrombolytic Agents (DL35428)
The comment period will close on December 15, 2019 for the following Proposed Local Coverage Determinations (LCDs):
Biomarkers for Oncology (DL35396)
Thrombolytic Agents (DL35428)
Submit Comments
The following Local Coverage Article which was posted for notice on October 17, 2019 is now effective:
Self-Administered Drug Exclusion List (A53127)
The following Local Coverage Determinations have been revised. The related Billing and Coding articles have also been revised or added.
Electroretinography (ERG) (L37371)
Billing and Coding: Electroretinography (ERG) (A56672)
Endovenous Stenting (L37893)
Billing and Coding: Endovenous Stenting (A56414)
Epidural Injections for Pain Management (L36920)
Billing and Coding: Epidural Injections for Pain Management (A56681)
Evaluation and Management Services Provided in a Nursing Facility (L35068)
Billing and Coding: Evaluation and Management Services Provided in a Nursing Facility (A56712)
Facet Joint Interventions for Pain Management (L34892)
Billing and Coding: Facet Joint Interventions for Pain Management (A56670)
Nusinersen (Spinraza) (L37682)
Billing and Coding: Nusinersen (Spinraza) (A56860)
Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography (L35035)
Billing and Coding: Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography (A56631)
Trigger Point Injections (L35010)
Billing and Coding: Trigger Point Injections (A57751)
Vertebroplasty, Vertebral Augmentation (Kyphoplasty) Percutaneous (L35130)
Billing and Coding: Vertebroplasty, Vertebral Augmentation (Kyphoplasty) Percutaneous (A57752)
Wireless Capsule Endoscopy (L35089)
Billing and Coding: Wireless Capsule Endoscopy (A57753)
Wound Care (L35125)
Billing and Coding: Wound Care (A53001)
The following LCD has been revised:
Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs) (L38229)
The following Billing and Coding Articles have been revised:
Billing and Coding: Auricular Peripheral Nerve Stimulation (Electro-Acupuncture Device) (A55240)
Billing and Coding: Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Physician Requirements
(A55758)
Billing and Coding: Compounded Drugs Used in an Implantable Infusion Pump (A54100)
Billing and Coding: Endovascular Repair of Aortic and/or Iliac Aneurysms (A53124)
Billing and Coding: eVox® System and Other Electroencephalograph Testing for Memory Loss (A56440)
Billing and Coding: Isolated Ultrafiltration for Management of Fluid Overload in Cardiac Disease (A53126)
Billing and Coding: Laboratory Panels (A56473)
Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Oncologic Conditions (A53132)
Billing and Coding: Prepackaged Kits (A54515)
Billing and Coding: Prolonged Drug and Biological Infusions Started Incident To a Physician’s Service Using an External Pump (A55134)
Billing and Coding: Rezum® Procedure (A55352)
Billing and Coding: Ventricular Assist Device (VAD) Supply or Accessory (A54910)
The following LCD and the related Billing and Coding Article have been retired for dates of service on and after November 21, 2019:
Sclerotherapy and Endovenous Non-Thermal Treatment of Varicose Veins (L37796)
Sclerotherapy and Endovenous Non-Thermal Treatment of Varicose Veins (A56268)
The following Local Coverage Determinations (LCDs) posted for comment on June 27, 2019 have been posted for notice. The LCDs and related Billing and Coding Articles will become effective December 30, 2019:
4Kscore Test Algorithm (L37792)
Billing and Coding: 4Kscore Test Algorithm (A56653)
Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs)( L38229)
Billing and Coding: Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs) (A56642)
Micro-Invasive Glaucoma Surgery (MIGS) (L38223)
Billing and Coding: Micro-Invasive Glaucoma Surgery (MIGS) (A56633)
The following Response to Comment Articles contain summaries of all comments received and Novitas’ responses:
Response to Comments: 4Kscore Test Algorithm (A57729)
Response to Comments: Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs) (A57732)
Response to Comments: Micro-Invasive Glaucoma Surgery (MIGS) (A57735)
The following Local Coverage Determinations have been revised. The related Billing and Coding articles, if applicable, have been added or revised.
Allergen Immunotherapy (L36240)
Billing and Coding: Allergen Immunotherapy (A56538)
Ambulance Services (Ground Ambulance) (L35162)
Billing and Coding: Ambulance Services (Ground Ambulance) (A54574)
Anorectal Manometry, Anal Electromyography, and Biofeedback Training for Perineal Muscles and Anorectal or Urethral Sphincters (L34977)
Billing and Coding: Anorectal Manometry, Anal Electromyography, and Biofeedback Training for Perineal Muscles and Anorectal or Urethral Sphincters (A56530)
Autonomic Function Tests (L35395)
Billing and Coding: Autonomic Function Tests (A54954)
Barium Swallow Studies, Modified (L35433)
Billing and Coding: Barium Swallow Studies, Modified (A56589)
Biomarkers for Oncology (L35396)
Flow Cytometry (L35032)
Billing and Coding: Flow Cytometry (A56676)
Hemophilia Factor Products (L35111)
Billing and Coding: Hemophilia Factor Products (A56433)
Hyperbaric Oxygen (HBO) Therapy (L35021)
Billing and Coding: Hyperbaric Oxygen (HBO) Therapy (A56714)
Implantable Infusion Pump (L35112)
Billing and Coding: Implantable Infusion Pump (A56778)
In Vitro Chemosensitivity & Chemoresistance Assays (L36634)
Billing and Coding: In Vitro Chemosensitivity & Chemoresistance Assays (A56710)
Intensity Modulated Radiation Therapy (IMRT) (L36711)
Billing and Coding: Intensity Modulated Radiation Therapy (IMRT) (A56725)
Intraoperative Neurophysiological Testing (L35003)
Billing and Coding: Intraoperative Neurophysiological Testing (A56722)
Intravenous Immune Globulin (IVIG) (L35093)
Billing and Coding: Intravenous Immune Globulin (IVIG) (A56786)
Lacrimal Punctum Plugs (L35095)
Billing and Coding: Lacrimal Punctum Plugs (A56780)
Loss-of-Heterozygosity Based Topographic Genotyping with PathfinderTG ® (L34864)
Billing and Coding: Loss-of-Heterozygosity Based Topographic Genotyping with Pathfinder TG® (A56897)
Lower Extremity Major Joint Replacement (Hip and Knee) (L36007)
Billing and Coding: Lower Extremity Major Joint Replacement (Hip and Knee) (A56796)
Luteinizing Hormone-Releasing Hormone (LHRH) Analogs (L34822)
Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs (A56776)
Microvascular Therapy (L36434)
Billing and Coding: Microvascular Therapy (MVT) (A54343)
Mohs Micrographic Surgery (MMS) (L34961)
Billing and Coding: Mohs Micrographic Surgery (MMS) (A53883)
Multiple Imaging in Oncology (L35391)
Billing and Coding: Multiple Imaging in Oncology (A56848)
Neuromuscular Junction Testing (L34996)
Billing and Coding: Neuromuscular Junction Testing (A56785)
Outpatient Wireless Pulmonary Artery Pressure Monitoring for Heart Failure (L36419)
Billing and Coding: Outpatient Wireless Pulmonary Artery Pressure Monitoring for Heart Failure (A56856)
Surgery: Posterior Tibial Nerve Stimulation (PTNS) for Urinary Control (L35011)
Billing and Coding: Surgery: Posterior Tibial Nerve Stimulation (PTNS) for Urinary Control (A57712)
Therapy and Rehabilitation Services (PT, OT) (L35036)
Billing and Coding: Therapy and Rehabilitation Services (PT, OT) (A57703)
Treatment of Varicose Veins and Venous Stasis Disease of the Lower Extremities (L34924)
Billing and Coding: Treatment of Varicose Veins and Venous Stasis Disease of the Lower Extremities (A55229)
The following Billing and Coding Articles have been revised:
Billing and Coding: 3D Interpretation and Reporting of Imaging Studies (A56526)
Billing and Coding: Acute Care: Inpatient, Observation and Treatment Room Services (A52985)
The following Local Coverage Determinations (LCDs) and related Billing and Coding articles have been revised.
Biomarkers Overview (L35062)
Billing and Coding: Biomarkers Overview (A56541)
Blood Glucose Monitoring in a Skilled Nursing Facility (SNF) (L34834)
Billing and Coding: Blood Glucose Monitoring in a Skilled Nursing Facility (SNF) (A56591)
BRCA1 and BRCA2 Genetic Testing (L36715)
Billing and Coding: BRCA1 and BRCA2 Genetic Testing (A56542)
Cataract Extraction (including Complex Cataract Surgery) (L35091)
Billing and Coding: Cataract Extraction (including Complex Cataract Surgery) (A56615)
Chiropractic Services (L35424)
Billing and Coding: Chiropractic Services (A52987)
Co-Management of Surgical Procedures (L34862)
Billing and Coding: Co-Management of Surgical Procedures (A52989)
Corus® CAD Test (L36713)
Billing and Coding: Corus® CAD Test (A56608)
Cosmetic and Reconstructive Surgery (L35090)
Billing and Coding: Cosmetic and Reconstructive Surgery (A56587)
C-Reactive Protein High Sensitivity Testing (hsCRP) (L34856)
Billing and Coding: C-Reactive Protein High Sensitivity Testing (hsCRP) (A56643)
Diagnostic Abdominal Aortography and Renal Angiography (L35092)
Billing and Coding: Diagnostic Abdominal Aortography and Renal Angiography (A56682)
Frequency of Laboratory Tests (L35099)
Billing and Coding: Frequency of Laboratory Tests (A56420)
The following Billing and Coding article has been revised.
Billing and Coding: Approved Drugs and Biologicals; Includes Cancer Chemotherapeutic Agents (A53049)
The following Local Coverage Determinations (LCDs) have been revised in response to reconsideration requests and are now posted as Proposed LCDs. The Proposed LCDs are open for comments related to the current revisions only. Please refer to the Synopsis of Changes, Summary of Evidence and Analysis of Evidence sections for information pertinent to the revisions that are open for comment. The comment period will end on December 15, 2019.
Biomarkers for Oncology (DL35396)
Thrombolytic Agents (DL35428)
Submit Comments
The following draft Billing and Coding articles are related to the above Proposed LCDs. The articles contain the applicable CPT/HCPCS codes, ICD-10 Codes and billing and coding information.
Billing and Coding: Biomarkers for Oncology (DA52986)
Billing and Coding: Thrombolytic Agents (DA55237)
The following Local Coverage Determinations (LCDs) have been revised. The related Billing and Coding articles for these LCDs have been added or revised.
3D Interpretation and Reporting of Imaging Studies (L35408)
Billing and Coding: 3D Interpretation and Reporting of Imaging Studies (A56526)
4Kscore Test Algorithm (L37792)
Billing and Coding: Coding for 4Kscore Test Algorithm (A56281)
Hyaluronan Acid Therapies for Osteoarthritis of the Knee (L35427)
Billing and Coding: Hyaluronan Acid Therapies for Osteoarthritis of the Knee (A55036)
Nerve Conduction Studies and Electromyography (L35081)
Billing and Coding: Nerve Conduction Studies and Electromyography (A54095)
Sacral Nerve Stimulation (L35449)
Billing and Coding: Sacral Nerve Stimulation (A57617)
Scanning Computerized Ophthalmic Diagnostic Imaging (L35038)
Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (A57600)
Speech-Language Pathology (SLP) Services: Communication Disorders (L35070)
Billing and Coding: Speech-Language Pathology (SLP) Services: Communication Disorders (A54111)
Speech-Language Pathology (SLP) Services: Dysphagia; Includes VitalStim® Therapy (L34891)
Billing and Coding: Speech-Language Pathology (SLP) Services: Dysphagia; Includes VitalStim® Therapy (A57656)
Surgery: Blepharoplasty (L35004)
Billing and Coding: Surgery: Blepharoplasty (A57618)
The following Billing and Coding article has been revised.
Billing and Coding: Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (A54117)
In response to the annual ICD-10 code update, the following Billing and Coding articles have been added or revised. The related Local Coverage Determinations (LCDs) have been revised to remove the codes and place them into the Billing and Coding articles.
Billing and Coding: Monitored Anesthesia Care (A57361)
Monitored Anesthesia Care (L35049)
Billing and Coding: Oximetry Services (A57205)
Oximetry Services (L35434)
Billing and Coding: Pulmonary Function Testing (A57320)
Pulmonary Function Testing (L35360)
Billing and Coding: Real-Time, Outpatient Cardiac Telemetry (A52995)
Real-Time, Outpatient Cardiac Telemetry (L34997)
Billing and Coding: Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic) (A57414)
Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic) (L35350)
Billing and Coding: Vestibular and Audiologic Function Studies (A57434)
Vestibular and Audiologic Function Studies (L35007)
In response to the 2020 annual ICD-10 code update, the following Billing and Coding Articles have been revised. Related LCDs, as applicable, have undergone a system change to remove the coding sections.
Billing and Coding: Allergy Testing (A56558)
Allergy Testing (L36241)
Billing and Coding: Assays for Vitamins and Metabolic Function (A56416)
Assays for Vitamins and Metabolic Function (L34914)
Billing and Coding: Bariatric Surgical Management of Morbid Obesity (A56422)
Bariatric Surgical Management of Morbid Obesity (L35022)
Billing and Coding: Cardiac Event Detection Monitoring (A56600)
Cardiac Event Detection Monitoring (L34953)
Billing and Coding: Cardiac Rhythm Device Evaluation (A56602)
Cardiac Rhythm Device Evaluation (L34833)
Billing and Coding: Cardiovascular Nuclear Medicine (A56423)
Cardiovascular Nuclear Medicine (L35083)
Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing (A56645)
Controlled Substance Monitoring and Drugs of Abuse Testing (L35006)
Billing and Coding: Implantable Automatic Defibrillators (A56355)
Billing and Coding: Magnetic Resonance Angiography (MRA) (A56805)
Magnetic Resonance Angiography (MRA)( L34865)
Billing and Coding: Molecular Diagnostics: Genitourinary Infectious Disease Testing (A56791)
Molecular Diagnostics: Genitourinary Infectious Disease Testing (L35015)
Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions (A53134)
Billing and Coding: Neurophysiology Evoked Potentials (NEPs) (A56773)
Neurophysiology Evoked Potentials (NEPs) (L34975)
Billing and Coding: Non-Coronary Vascular Stents (A56365)
Non-Coronary Vascular Stents (L35084)
Billing and Coding: Non-Invasive Peripheral Venous Studies (A52993)
Non-Invasive Peripheral Venous Studies (L35451)
Billing and Coding: Non-Vascular Extremity Ultrasound (A55037)
Non-Vascular Extremity Ultrasound (L35409)
Billing and Coding: Routine Foot Care (A52996)
Routine Foot Care (L35138)
Billing and Coding: Single Chamber and Dual Chamber Permanent Cardiac Pacemakers (A54982)
Billing and Coding: Strapping (A56804)
Strapping (L36423)
Billing and Coding: Thrombolytic Agents (A55237)
Thrombolytic Agents (L35428)
Billing and Coding: Transesophageal Echocardiography (TEE) (A56505)
Transesophageal Echocardiography (TEE) (L35016)
The following Billing and Coding Articles have been revised. The related LCDs have been revised to remove the coding sections.
Billing and Coding: Hydration Therapy (A56634)
Hydration Therapy (L34960)
Billing and Coding: Non-Invasive Cerebrovascular Arterial Studies (A52992)
Non-Invasive Cerebrovascular Arterial Studies (L35397)
---------------------------------------------------------------------------------------------------------------
The Self-Administered Drug Exclusion List, A53127 has been revised and is posted for notice. The article will become effective December 2, 2019
Modifier JB Use for Drugs/Biologicals included on the Self-Administered Drug Exclusion List
Several drugs/biologicals that are considered self-administered and included on the Novitas Self-Administered Drug (SAD) Exclusion List may be administered intravenously or subcutaneously. Effective with claims submitted for dates of service on or after December 2, 2019, Novitas will require the use of the Healthcare Common Procedure Coding System (HCPCS) modifier when reporting subcutaneous administration of a drug/biological that is included on the Novitas Self-Administered Drug (SAD) Exclusion List.
Further information regarding Self-Administered Drugs is found on the Medical Policy Drugs & Biologicals: Self-Administered Drug Exclusions page.
The comment period is now closed for the following Proposed Local Coverage Determination (LCD). Comments received will be reviewed by our Contractor Medical Directors and a Response to Comments Article and a finalized Billing and Coding Article will be posted to our website and related to the LCD when it is posted for notice.
Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea (DL38385)
The following Draft Articles have replaced the Future Effective Articles and have been related to the Proposed LCDs:
Billing and Coding: 4Kscore Test Algorithm (DA56653)
4Kscore Test Algorithm (DL37792)
Billing and Coding: Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs) (DA56642)
Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs) (DL38229)
Billing and Coding: Hypoglossal Nerve Stimulation for Treatment of Obstructive Sleep Apnea (DA56938)
Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea (DL38385)
Billing and Coding: Micro-Invasive Glaucoma Surgery (MIGS) (DA56633)
Micro-Invasive Glaucoma Surgery (MIGS) (DL38223)
The comment period will close on October 13, 2019 for the following Proposed Local Coverage Determination (LCD):
Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea (DL38385)
Submit Comments
The Novitas Solutions medical policy team has evaluated all active Local Coverage Determinations (LCDs) and Local Coverage Articles for any impact in response to the 2020 Annual ICD-10 Code Update. The following is a list of the impacted LCDs and Articles. The revised Articles will be published to the Medicare Coverage Database and on the Novitas Website in the middle of October. Please continue to watch our website for updates.
Number |
Article/LCD Name |
A56558 |
Billing and Coding: Allergy Testing |
A56416 |
Billing and Coding: Assays for Vitamins and Metabolic Function |
A56422 |
Billing and Coding: Bariatric Surgical Management of Morbid Obesity |
A56600 |
Billing and Coding: Cardiac Event Detection Monitoring |
A56602 |
Billing and Coding: Cardiac Rhythm Device Evaluation |
A56423 |
Billing and Coding: Cardiovascular Nuclear Medicine |
A56645 |
Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing |
A56355 |
Billing and Coding: Implantable Automatic Defibrillators |
A56805 |
Billing and Coding: Magnetic Resonance Angiography (MRA) |
A56791 |
Billing and Coding: Molecular Diagnostics: Genitourinary Infectious Disease Testing |
A53134 |
NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions |
A56773 |
Billing and Coding: Neurophysiology Evoked Potentials (NEPs) |
A56365 |
Billing and Coding: Non-Coronary Vascular Stents |
A52993 |
Billing and Coding: Non-Invasive Peripheral Venous Studies |
A55037 |
Billing and Coding: Non-Vascular Extremity Ultrasound |
A52996 |
Billing and Coding: Routine Foot Care |
A54982 |
Single Chamber and Dual Chamber Permanent Cardiac Pacemakers - Coding and Billing |
A56804 |
Billing and Coding: Strapping |
A55237 |
Billing and Coding: Thrombolytic Agents |
A56505 |
Billing and Coding: Transesophageal Echocardiography (TEE) |
L35049 |
Monitored Anesthesia Care |
L35434 |
Oximetry Services |
L35360 |
Pulmonary Function Testing |
L34997 |
Real-Time, Outpatient Cardiac Telemetry |
L35350 |
Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic) |
L35007 |
Vestibular and Audiologic Function Studies |
The following Local Coverage Determinations (LCDs) have been revised. The related Billing and Coding Articles for these LCDs have been added or revised.
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (L35041)
Billing and Coding: Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (A54117)
Frequency of Hemodialysis (L35014)
Billing and Coding: Frequency of Hemodialysis (A55723)
Independent Diagnostic Testing Facility (IDTF) (L35448)
Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A53252)
Prostate Mapping Biopsy (L35009)
Billing and Coding: Prostate Mapping Biopsy (A56966)
Psychiatric Codes (L35101)
Billing and Coding: Psychiatric Codes (A57130)
Removal of Benign Skin Lesions (L34938)
Billing and Coding: Removal of Benign Skin Lesions (A57113)
Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder
(L34998)
Billing and Coding: Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder (A57072)
Spinal Cord Stimulation (Dorsal Column Stimulation) (L35450)
Billing and Coding: Spinal Cord Stimulation (Dorsal Column Stimulation) (A57023)
Surgical Treatment of Nails (L34887)
Billing and Coding: Surgical Treatment of Nails (A52998)
The following Local Coverage Determinations (LCDs) have been revised. The related Billing and Coding Articles for these LCDs have been added or revised:
Debridement of Mycotic Nails (L35013)
Billing and Coding: Debridement of Mycotic Nails (A56640)
Outpatient Sleep Studies (L35050)
Billing and Coding: Outpatient Sleep Studies (A56923)
Reflectance Confocal Microscopy (L37375)
Billing and Coding: Reflectance Confocal Microscopy (A56969)
Services That Are Not Reasonable and Necessary (L35094)
Billing and Coding: Services That Are Not Reasonable and Necessary (A56967)
The following Billing and Coding Articles have been revised:
Billing and Coding: Biomarkers for Oncology (A52986)
Billing and Coding: Implantable Automatic Defibrillators (A56355)
Billing and Coding: Information Regarding Uses, Including Off-Label Uses, of Anti-Vascular Endothelial Growth Factor (anti-VEGF), for The Treatment of Ophthalmological Diseases (A53121)
The following Proposed Local Coverage Determination (LCD) has been posted for comment. The comment period will end on October 13, 2019:
Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea (DL38385)
Submit Comments
The following future effective related billing and coding article has been added:
Billing and Coding: Hypoglossal Nerve Stimulation for Treatment of Obstructive Sleep Apnea (A56938)
The following Local Coverage Determinations (LCDs) have been revised. The related Billing and Coding Articles for these LCDs have been added or revised:
Intravenous Immune Globulin (IVIG) (L35093)
Billing and Coding: Intravenous Immune Globulin (IVIG) (A56786)
Loss-of-Heterozygosity Based Topographic Genotyping with PathfinderTG ® (L34864)
Billing and Coding: Loss-of-Heterozygosity Based Topographic Genotyping with Pathfinder TG® (A56897)
Microvascular Therapy (L36434)
Billing and Coding: Microvascular Therapy (MVT) (A54343)
Multiple Imaging in Oncology (L35391)
Billing and Coding: Multiple Imaging in Oncology (A56848)
Non-Vascular Extremity Ultrasound (L35409)
Billing and Coding: Non-Vascular Extremity Ultrasound (A55037)
Nusinersen (Spinraza) (L37682)
Billing and Coding: Nusinersen (Spinraza) (A56860)
Outpatient Wireless Pulmonary Artery Pressure Monitoring for Heart Failure (L36419)
Billing and Coding: Outpatient Wireless Pulmonary Artery Pressure Monitoring for Heart Failure (A56856)
Strapping (L36423)
Billing and Coding: Strapping (A56804)
The following LCD has been revised:
Facet Joint Interventions for Pain Management (L34892)
The following Billing and Coding Articles have been revised:
Billing and Coding Information Regarding Uses, Including Off-Label Uses, of Anti-Vascular Endothelial Growth Factor (anti-VEGF), for The Treatment of Ophthalmological Diseases (A53121)
Billing and Coding: Implantable Automatic Defibrillators (A56355)
The comment period is now closed for the following Proposed Local Coverage Determinations (LCDs). Comments received will be reviewed by our Contractor Medical Directors and Response to Comments Articles will be posted to our website and related to the LCDs when they are posted for notice.
4Kscore Test Algorithm (DL37792)
Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATS) (DL38229)
Micro-Invasive Glaucoma Surgery (MIGS) (DL38223)
The following Local Coverage Determinations (LCDs) have been revised. The related Billing and Coding Articles for these LCDs have been added:
Implantable Infusion Pump (L35112)
Billing and Coding: Implantable Infusion Pump (A56778)
Intravenous Immune Globulin (IVIG) (L35093)
Billing and Coding: Intravenous Immune Globulin (IVIG) (A56786)
Lacrimal Punctum Plugs (L35095)
Billing and Coding: Lacrimal Punctum Plugs (A56780)
Lower Extremity Major Joint Replacement (Hip and Knee) (L36007)
Billing and Coding: Lower Extremity Major Joint Replacement (Hip and Knee) (A56796)
Luteinizing Hormone-Releasing Hormone (LHRH) Analogs (L34822)
Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs (A56776)
Magnetic Resonance Angiography (MRA) (L34865)
Billing and Coding: Magnetic Resonance Angiography (MRA) (A56805)
Molecular Diagnostics: Genitourinary Infectious Disease Testing (L35015)
Billing and Coding: Molecular Diagnostics: Genitourinary Infectious Disease Testing (A56791)
Neuromuscular Junction Testing (L34996)
Billing and Coding: Neuromuscular Junction Testing (A56785)
Neurophysiology Evoked Potentials (NEPs) (L34975)
Billing and Coding: Neurophysiology Evoked Potentials (NEPs) (A56773)
The following Billing and Coding Article has been revised:
Billing and Coding: Cardiovascular Nuclear Medicine (A56423)
The comment period will close on August 11, 2019 for the following Proposed Local Coverage Determinations (LCDs):
4Kscore Test Algorithm (DL37792)
Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATS) (DL38229)
Micro-Invasive Glaucoma Surgery (MIGS) (DL38223)
Submit Comments
The following Local Coverage Determinations (LCDs) have been revised. The related Billing and Coding articles for these LCDs have been added:
Evaluation and Management Services Provided in a Nursing Facility (L35068)
Billing and Coding: Evaluation and Management Services Provided in a Nursing Facility (A56712)
Flow Cytometry (L35032)
Billing and Coding: Flow Cytometry (A56676)
Hyperbaric Oxygen (HBO) Therapy (L35021)
Billing and Coding: Hyperbaric Oxygen (HBO) Therapy (A56714)
Intensity Modulated Radiation Therapy (IMRT) (L36711)
Billing and Coding: Intensity Modulated Radiation Therapy (IMRT) (A56725)
Intraoperative Neurophysiological Testing (L35003)
Billing and Coding: Intraoperative Neurophysiological Testing (A56722)
In Vitro Chemosensitivity & Chemoresistance Assays (L36634)
Billing and Coding: In Vitro Chemosensitivity & Chemoresistance Assays (A56710)
The following Local Coverage Determination (LCD) has been revised
Services That Are Not Reasonable and Necessary (L35094)
The following Local Coverage Article has been revised:
Billing and Coding: Hemophilia Factor Products (A56433)
The following Local Coverage Determinations (LCDs) have been revised. The related Billing and Coding articles for these LCDs have been added:
Debridement of Mycotic Nails (L35013)
Billing and Coding: Debridement of Mycotic Nails (A56640)
Diagnostic Abdominal Aortography and Renal Angiography (L35092)
Billing and Coding: Diagnostic Abdominal Aortography and Renal Angiography (A56682)
Electroretinography (ERG) (L37371)
Billing and Coding: Electroretinography (ERG) (A56672)
Epidural Injections for Pain Management (L36920)
Billing and Coding: Epidural Injections for Pain Management (A56681)
Facet Joint Interventions for Pain Management (L34892)
Billing and Coding: Facet Joint Interventions for Pain Management (A56670)
Hydration Therapy (L34960)
Billing and Coding: Hydration Therapy (A56634)
The following Local Coverage Article has been revised:
Independent Diagnostic Testing Facility (IDTF) (A53252)
The following Local Coverage Determination (LCD) has been revised. The related Billing and Coding article has also been revised:
Frequency of Hemodialysis (L35014)
Billing and Coding: Frequency of Hemodialysis (A55723)
The following Proposed Local Coverage Determinations (LCDs) have been posted for comment. The comment period will end on August 11, 2019:
4Kscore Test Algorithm (DL37792)
Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs) (DL38229)
Micro-Invasive Glaucoma Surgery (MIGS) (DL38223)
Submit Comments
The following future effective related billing and coding articles have been added:
Billing and Coding: 4Kscore Test Algorithm (A56653)
Billing and Coding: Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Acid Amplification Techniques (NAATs) (A56642)
Billing and Coding: Micro-Invasive Glaucoma Surgery (MIGS) (A56633)
The following Local Coverage Determinations (LCDs) have been revised. The related Billing and Coding articles for these LCDs have been added or revised:
Controlled Substance Monitoring and Drugs of Abuse Testing (L35006)
Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing (A56645)
C-Reactive Protein High Sensitivity Testing (hsCRP) (L34856)
Billing and Coding: C-Reactive Protein High Sensitivity Testing (hsCRP) (A56643)
Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography (L35035)
Billing and Coding: Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography (A56631)
The following Local Coverage Articles have been revised:
Billing and Coding: Ambulance Services (Ground Ambulance) (A54574)
Billing and Coding: Cosmetic and Reconstructive Surgery (A56587)
The following Local Coverage Determinations (LCDs) have been revised. The related Billing and Coding articles for these LCDs have been added or revised:
Biomarkers for Oncology (L35396)
Billing and Coding: Biomarkers for Oncology (A52986)
Blood Glucose Monitoring in a Skilled Nursing Facility (SNF) (L34834)
Billing and Coding: Blood Glucose Monitoring in a Skilled Nursing Facility (SNF) (A56591)
Cardiac Event Detection Monitoring (L34953)
Billing and Coding: Cardiac Event Detection Monitoring (A56600)
Cardiac Rhythm Device Evaluation (L34833)
Billing and Coding: Cardiac Rhythm Device Evaluation (A56602)
Cataract Extraction (including Complex Cataract Surgery) (L35091)
Billing and Coding: Cataract Extraction (including Complex Cataract Surgery) (A56615)
Corus® CAD Test (L36713)
Billing and Coding: Corus® CAD Test (A56608)
Ongoing Revisions to LCD Format
Consistent with Change Request (CR) 10901 language from National Coverage Determinations and/or CMS manuals must be removed from our Local Coverage Determinations (LCDs) and replaced with the applicable references. Also HCPCS/CPT codes and ICD-10 codes will be removed from LCDs and placed in Local Coverage Articles.
This change began with the LCD revisions on February 14, 2019 with an expectation of completion by December 31, 2019. The above changes will alter the look of our LCDs; however, the “Revision History Information” will continue to provide a clear explanation for any modifications.
The following Local Coverage Determinations (LCDs) have been revised. The related Billing and Coding articles for these LCDs have been added or revised:
Barium Swallow Studies, Modified (L35433)
Billing and Coding: Barium Swallow Studies, Modified (A56589)
Biomarkers Overview (L35062)
Billing and Coding: Biomarkers Overview (A56541)
BRCA1 and BRCA2 Genetic Testing (L36715)
Billing and Coding: BRCA1 and BRCA2 Genetic Testing (A56542)
Cosmetic and Reconstructive Surgery (L35090)
Billing and Coding: Cosmetic and Reconstructive Surgery (A56587)
The following articles have been revised:
Billing and Coding: Bariatric Surgical Management of Morbid Obesity (A56422)
Independent Diagnostic Testing Facility (IDTF) (A53252)
The following Local Coverage Determinations (LCDs) which were posted for notice on April 4, 2019 are now effective. The related Billing and Coding articles for these LCDs are also now effective:
Endovenous Stenting (L37893)
Billing and Coding: Endovenous Stenting (A56414)
Hyaluronan Acid Therapies for Osteoarthritis of the Knee (L35427)
Billing and Coding: Hyaluronan Acid Therapies for Osteoarthritis of the Knee (A55036)
The following Local Coverage Determinations have been revised:
3D Interpretation and Reporting of Imaging Studies (L35408)
Allergen Immunotherapy (L36240)
Allergy Testing (L36241)
Anorectal Manometry, Anal Electromyography, and Biofeedback Training for Perineal Muscles and Anorectal or Urethral Sphincters (L34977)
Non-Coronary Vascular Stents (L35084)
The following Local Coverage Article has been revised:
Billing and Coding: Non-Coronary Vascular Stents (A56365)
The following Local Coverage Articles have been added:
Billing and Coding: 3D Interpretation and Reporting of Imaging Studies (A56526)
Billing and Coding: Allergen Immunotherapy (A56538)
Billing and Coding: Allergy Testing (A56558)
Billing and Coding: Anorectal Manometry, Anal Electromyography, and Biofeedback Training for Perineal Muscles and Anorectal or Urethral Sphincters (A56530)
Implementation of the following Local Coverage Determination (LCD) is being delayed. This LCD will not become effective on May 7, 2019. Please watch our website for updates regarding this LCD.
Sclerotherapy and Endovenous Non-Thermal Treatment of Varicose Veins (L37796)
Implementation of the following Local Coverage Article is being delayed. This article will not become effective on May 7, 2019. Please watch our website for updates regarding this article.
Coding Article for Sclerotherapy and Endovenous Non-Thermal Treatment of Varicose Veins (A56268)
The following Local Coverage Determinations have been revised:
Hemophilia Factor Products (L35111)
Mohs Micrographic Surgery (MMS) (L34961)
Thrombolytic Agents (L35428)
Transesophageal Echocardiography (TEE) (L35016)
Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic) (L35350)
Vertebroplasty, Vertebral Augmentation (Kyphoplasty) Percutaneous (L35130)
Vestibular and Audiologic Function Studies (L35007)
The following Local Coverage Articles have been revised and the titles have been changed:
Billing and Coding: Mohs Micrographic Surgery (MMS) (A53883)
Billing and Coding: Thrombolytic Agents (A55237)
The following Local Coverage Articles have been added:
Billing and Coding: Hemophilia Factor Products (A56433)
Billing and Coding: Transesophageal Echocardiography (TEE) (A56505)
The following Local Coverage Determinations have been revised:
Outpatient Sleep Studies (L35050)
Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder (L34998)
Sacral Nerve Stimulation (L35449)
Scanning Computerized Ophthalmic Diagnostic Imaging (L35038)
Surgery: Posterior Tibial Nerve Stimulation (PTNS) for Urinary Control (L35011)
Surgical Treatment of Nails (L34887)
Therapy and Rehabilitation Services (PT, OT) (L35036)
Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography (L35035)
Treatment of Varicose Veins and Venous Stasis Disease of the Lower Extremities (L34924)
Wound Care (L35125)
The following Local Coverage Articles have been revised:
Approved Drugs and Biologicals; Includes Cancer Chemotherapeutic Agents (A53049)
Billing and Coding: Assays for Vitamins and Metabolic Function (A56416)
Billing and Coding: Surgical Treatment of Nails (A52998)
Billing and Coding: Wound Care (A53001)
Endovascular Repair of Aortic and/or Iliac Aneurysms (A53124)
The following Local Coverage Determinations have been revised:
Hydration Therapy (L34960)
Hyperbaric Oxygen (HBO) Therapy (L35021)
Intravenous Immune Globulin (IVIG) (L35093)
Lower Extremity Major Joint Replacement (Hip and Knee) (L36007)
Luteinizing Hormone-Releasing Hormone (LHRH) Analogs (L34822)
Monitored Anesthesia Care (L35049)
Routine Foot Care (L35138)
The following Local Coverage Article has been added:
Billing and Coding: Laboratory Panels (A56473)
The following Local Coverage Article has been revised and the title has been changed:
Billing and Coding: Routine Foot Care (A52996)
The following Local Coverage Determinations (LCDs) posted for comment on September 20, 2018 and presented at the October 2018 Contractor Advisory Committee (CAC) Meeting have been posted for notice. They will become effective May 20, 2019:
Endovenous Stenting (L37893)
Hyaluronan Acid Therapies for Osteoarthritis of the Knee (L35427)
The following related Local Coverage Articles will become effective on May 20, 2019:
Billing and Coding: Endovenous Stenting (A56414)
Billing and Coding: Hyaluronan Acid Therapies for Osteoarthritis of the Knee (A55036)
The following Local Coverage Articles contain summaries of comments received and Novitas’ responses:
Response to Comments: Endovenous Stenting (A56415)
Response to Comments: Hyaluronan Acid Therapies for Osteoarthritis of the Knee (A56412)
The following Local LCD has been revised:
Biomarkers for Oncology (L35396)
The following related Local Coverage Article has been revised and has a title change:
Billing and Coding: Biomarkers for Oncology (A52986)
The following LCD has been revised:
Psychiatric Codes (L35101)
The following Local Coverage Article has been added:
Billing and Coding: eVox® System and Other Electroencephalograph Testing for Memory Loss (A56440)
The following Local Coverage Determinations have been revised:
Assays for Vitamins and Metabolic Function (L34914)
Bariatric Surgical Management of Morbid Obesity (L35022)
Cardiovascular Nuclear Medicine (L35083)
Cataract Extraction (including Complex Cataract Surgery) (L35091)
Chiropractic Services (L35424)
Frequency of Laboratory Tests (L35099)
The following Local Coverage Article has been revised. (Please note that the Article title has been changed):
Billing and Coding: Chiropractic Services (A52987)
The following Local Coverage Articles have been added:
Billing and Coding: Assays for Vitamins and Metabolic Function (A56416)
Billing and Coding: Bariatric Surgical Management of Morbid Obesity (A56422)
Billing and Coding: Cardiovascular Nuclear Medicine (A56423)
Billing and Coding: Frequency of Laboratory Tests (A56420)
The following Local Coverage Determination (LCD) which was posted for notice on January 31, 2019 is now effective. The companion article for this LCD is also now effective:
4Kscore Test Algorithm (L37792)
Coding for 4Kscore Test Algorithm (A56281)
The following Local Coverage Determination (LCD) which was posted for notice on January 31, 2019 has been placed on hold. The LCD will not become effective on March 21, 2019. The new Notice Period End date for this LCD is now May 6, 2019 and it will become effective May 7, 2019.
Sclerotherapy and Endovenous Non-Thermal Treatment of Varicose Veins (L37796)
The following article will now become effective May 7, 2019 to coincide with the new effective date of Local Coverage Determination (LCD) L37796:
Coding Article for Sclerotherapy and Endovenous Non-Thermal Treatment of Varicose Veins (A56268)
The following Local Coverage Determinations have been revised:
Ambulance Services (Ground Ambulance) (L35162)
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (L35041)
Autonomic Function Tests (L35395)
Non Invasive Cerebrovascular Arterial Studies (L35397)
Non Invasive Peripheral Venous Studies (L35451)
Non-Coronary Vascular Stents (L35084)
The following Local Coverage Articles have been revised. (Please note that the Article titles have been changed):
Billing and Coding: Ambulance Services (Ground Ambulance) (A54574)
Billing and Coding: Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (A54117)
Billing and Coding: Autonomic Function Tests (A54954)
Billing and Coding: Non Invasive Cerebrovascular Arterial Studies (A52992)
Billing and Coding: Non Invasive Peripheral Venous Studies (A52993)
The following article has been added:
Billing and Coding Article: Non Coronary Vascular Stents (A56365)
The following JH Local Coverage Determination (LCD) has been placed on hold and will not become effective on March 21, 2019. Please watch our website for updates regarding this LCD and its effective date.
Sclerotherapy and Endovenous Non-Thermal Treatment of Varicose Veins (L37796)
The following JH Local Coverage Article has been placed on hold and will not become effective on March 21, 2019. Please watch our website for updates regarding this Article and its effective date.
Coding Article for Sclerotherapy and Endovenous Non-Thermal Treatment of Varicose Veins (A56268)
Multi-jurisdictional Contractor Advisory Committee (CAC) via Webex on March 20, 2019
As previously communicated on February 22, 2019 the Medicare Administrative Contractors (MACs) will host a multi-jurisdictional Contractor Advisory Committee (CAC) via Webex on March 20, 2019, 1-4 pm EST hosted by National Government Services.
The conference will be by teleconference only. Please plan to record your voting responses during the meeting directly on the voting questions Word document and return them to Novitas Solutions at MedicalAffairs@novitas-solutions.com.
You may join Webex by calling 844-824-1430 and entering the conference ID 4983205.
Click here for additional information regarding this meeting.
The following Local Coverage Determination (LCD) which was posted for notice on January 10, 2019 is now effective:
Frequency of Hemodialysis (L35014)
The following Coding Article is now effective:
Coding for Hemodialysis Sessions (A55723)
The following Local Coverage Determination (LCD) has been revised:
Psychiatric Codes (L35101)
In response to Change Request 10901, the following Local Coverage Determination (LCD) has been revised to remove the Current Procedural Terminology (CPT) Codes:
Independent Diagnostic Testing Facility (IDTF) (L35448)
The following Local Coverage Article has been revised:
Independent Diagnostic Testing Facility (IDTF) (A53252)
The following article has been added. It will become effective March 26, 2019
Billing and Coding Article: Implantable Automatic Defibrillators (A56355)
As previously communicated on February 15, 2019 the Medicare Administrative Contractors (MACs) will host a multi-jurisdictional Contractor Advisory Committee (CAC) via Webex on March 20, 2019, 1-4 pm EST which will be led by National Government Services.
The purpose of the meeting is to obtain advice from CAC members and subject matter experts (SMEs) regarding the strength of published evidence on Percutaneous Vertebral Augmentation (PVA) for osteoporotic Vertebral Compression Fracture (VCF). In addition to discussion, the CAC and SME panel will vote on pre-distributed questions. The public is invited to attend as observers.
Ever since two high profile, methodologically controversial, randomized controlled trials (RCTs) found no benefit of percutaneous vertebroplasty over sham in 2009, there has been a lack of consensus on the appropriate management of osteoporotic VCF, particularly the role of PVA. After several recent publications further question the value of PVA, Contractor Medical Directors (CMDs) thought it appropriate to reassess current Medicare coverage. CAC panels do not make coverage determinations, but MACs benefit from their advice.
E-mail correspondence regarding this meeting with additional information is being sent to the Novitas CAC members. Any Novitas CAC member or SME located within the Novitas jurisdiction interested in participating in this multi-jurisdictional meeting should contact Novitas Solutions at MedicalAffairs@novitas-solutions.com.
Tentative questions that the CAC members and SMEs will be asked to provide advice on are in the Voting Questions link below along with a bibliography listing in the Vertebral Augmentation Bibliography link below. Final questions and an agenda will be posted to the Novitas Website March 13, 2019.
Voting Questions
Vertebral Augmentation Bibliography
The Centers for Medicare & Medicaid (CMS) issued Change Request 10865, Transmittal 213 on February 15, 2019, revising the implementation date for NCD 20.4 Implantable Cardiac Defibrillators (ICDs) to March 26, 2019. The Medicare Administrative Contractors (MACs) are instructed to implement NCD 20.4 at the local level; therefore, Novitas is publishing a related Billing and Coding Article on the Medicare Coverage Database (MCD) to assist providers with the proper reporting of these services. The Article will be published on the MCD and Novitas’ website on February 28, 2019.
The effective date of the following Local Coverage Determination (LCD) posted for notice on January 31, 2019 has been changed from February 28, 2019 to March 1, 2019. A note has been added to the LCD to reflect this change.
Frequency of Hemodialysis (L35014)
The effective date for the following Local Coverage Article has been changed from February 28, 2019 to March 1, 2019. A note has been added to the Article to reflect this change.
Coding for Hemodialysis Sessions (A55723)
Medicare Administrative Contractors (MACs) will host a multi-jurisdictional Contractor Advisory Committee (CAC) via Webex on March 20, 2019, 1-4 pm EST
The purpose of the meeting is to obtain advice from CAC members and subject matter experts (SMEs) regarding the strength of published evidence on Percutaneous Vertebral Augmentation (PVA) for osteoporotic Vertebral Compression Fracture (VCF). In addition to discussion, the CAC and SME panel will vote on pre-distributed questions. The public is invited to attend as observers.
Ever since two high profile, methodologically controversial, randomized controlled trials (RCTs) found no benefit of percutaneous vertebroplasty over sham in 2009, there has been a lack of consensus on the appropriate management of osteoporotic VCF, particularly the role of PVA. After several recent publications further question the value of PVA, Contractor Medical Directors (CMDs) thought it appropriate to reassess current Medicare coverage. CAC panels do not make coverage determinations, but MACs benefit from their advice.
A participant Disclosure Statement, background material, and tentative questions will be posted by 2/22; the agenda (including final questions and Webex details) will be posted 3/13/19.
Consistent with the new LCD process outlined in the Medicare Program Integrity Manual, Chapter 13, Section 13.5.1, language from statute, regulations, rulings interpretive manuals, etc. has been removed from the coverage and indications section of the revised Local Coverage Determinations (LCDs) listed below and replaced with the applicable references.
The following JH Local Coverage Determinations (LCDs) have been revised to reflect the Annual CPT/HCPCS Code updates effective for dates of service on and after January 1, 2019:
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (L35041)
Biomarkers for Oncology (L35396)
Biomarkers Overview (L35062)
BRCA1 and BRCA2 Genetic Testing (L36715)
Cardiac Rhythm Device Evaluation (L34833)
Electroretinography (ERG) (L37371)
Hemophilia Factor Products (L35111)
Hyaluronan Acid Therapies for Osteoarthritis of the Knee (L35427)
Independent Diagnostic Testing Facility (IDTF) (L35448)
Outpatient Wireless Pulmonary Artery Pressure Monitoring for Heart Failure (L36419)
Psychiatric Codes (L35101)
Services That Are Not Reasonable and Necessary (L35094)
Speech-Language Pathology (SLP) Services: Communication Disorders (L35070)
Spinal Cord Stimulation (Dorsal Column Stimulation) (L35450)
The following JH Local Coverage Articles have been revised to reflect the Annual CPT/HCPCS Code updates effective for dates of service on and after January 1, 2019:
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (A54117)
Billing and Coding for Rezum® Procedure (A55352)
Biomarkers for Oncology (A52986)
Hyaluronan Acid Therapies for Osteoarthritis of the Knee (A55036)
Independent Diagnostic Testing Facility (IDTF) (A53252)
Self-Administered Drug Exclusion List (A53127)
Speech-Language Pathology (SLP) Services: Communication Disorders (A54111)
The following Proposed Local Coverage Determinations (LCDs) posted for comment on May 17, 2018 and presented at the June 2018 Contractor Advisory Committee (CAC) Meeting have been posted for notice. They will become effective March 21, 2019.
4Kscore Test Algorithm (L37792)
Sclerotherapy and Endovenous Non-Thermal Treatment of Varicose Veins (L37796)
The following Local Coverage Articles will become effective March 21, 2019:
Coding for 4Kscore Test Algorithm (A56281)
Coding Article for Sclerotherapy and Endovenous Non-Thermal Treatment of Varicose Veins (A56268)
The following Articles contain summaries of comments received and Novitas’ responses:
Response to Comments: 4Kscore Test Algorithm (A56282)
Response to Comments: Sclerotherapy and Endovenous Non-Thermal Treatment of Varicose Veins (A56269)
The following Proposed Local Coverage Determination (LCD) posted for comment on September 14, 2017, and presented at the October 2017 Contractor Advisory Committee (CAC) Meeting has been posted for notice. It will become effective February 28, 2019:
Frequency of Hemodialysis (L35014)
The following article contains a summary of the comments received and responses to the Frequency of Hemodialysis Proposed LCD (DL35014):
Response to Comments: Frequency of Hemodialysis (A56224)
The following Local Coverage Article has been revised and will become effective February 28, 2019:
Coding for Hemodialysis Sessions (A55723)
In response to Change Request (CR) 10901, effective January 8, 2019 the Local Coverage Determination (LCD) process has changed. The Medical Policy Center located on the Novitas Solutions Website has been updated to reflect the new process. Important updates include changes to the Local Coverage Determination Process, the LCD Reconsideration Process, the Contractor Advisory Committee (CAC) Meetings and Open Meetings. Please visit our Website for the most up to date information related to the new LCD process.
The following JH Local Coverage Determination (LCD) is now effective after being posted for notice and has also been revised:
Facet Joint Interventions for Pain Management (L34892)
The following JH LCD has been revised:
Epidural Injections for Pain Management (L36920)
The following JH LCD has been retired for dates of service on and after January 2, 2019:
Facet Joint Injections (L34974)
The Novitas Solutions medical policy team has evaluated all active Local Coverage Determinations (LCDs) and Local Coverage Articles for any impact in response to the 2019 Annual HCPCS/CPT Code Update. The following is a list of the impacted LCDs and Articles.
The revised LCDs and Articles will be published to the Medicare Coverage Database and on our Website in February. Please continue to watch our website for updates.
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (L35041)
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (A54117)
Billing and Coding for Rezum® Procedure (A55352)
Biomarkers for Oncology (L35396)
Biomarkers for Oncology (A52986)
Biomarkers Overview (L35062)
BRCA1 and BRCA2 Genetic Testing (L36715)
Cardiac Rhythm Device Evaluation (L34833)
Electroretinography (ERG) (L37371)
Hemophilia Factor Products (L35111)
Hyaluronan Acid Therapies for Osteoarthritis of the Knee (L35427)
Hyaluronan Acid Therapies for Osteoarthritis of the Knee (A55036)
Independent Diagnostic Testing Facility (IDTF) (L35448)
Independent Diagnostic Testing Facility (IDTF) (A53252)
Outpatient Wireless Pulmonary Artery Pressure Monitoring for Heart Failure (L36419)
Psychiatric Codes (L35101)
Self-Administered Drug Exclusion List (A53127)
Services That Are Not Reasonable and Necessary (L35094)
Speech-Language Pathology (SLP) Services: Communication Disorders (L35070)
Speech-Language Pathology (SLP) Services: Communication Disorders (A54111)
Spinal Cord Stimulation (Dorsal Column Stimulation) (L35450)
The following JH Local Coverage Determination (LCD) has been revised:
Intraoperative Neurophysiological Testing (L35003)
The hold has been lifted from the following JH Local Coverage Determination and it will become effective for dates of service on and after January 3, 2019. No changes have been made to the content of this LCD since it was placed on hold. The LCD below reflects the effective date of January 3, 2019 and an updated revision history.
Facet Joint Interventions for Pain Management (L34892)
The following JH local Coverage Determinations have been revised:
Hyperbaric Oxygen (HBO) Therapy (L35021)
Intensity Modulated Radiation Therapy (IMRT) (L36711)
The hold is being lifted from the following JH Local Coverage Determination (LCD) and it will become effective for dates of service on and after January 3, 2019. No changes are being made to the content of the LCD since it was placed on hold. The LCD with the new revision effective date of January 3 will be posted to our website on December 6, 2018:
Facet Joint Interventions for Pain Management (L34892)
The comment period is now closed for the following JH Draft Local Coverage Determinations (LCDs). Comments received will be reviewed by our Contractor Medical Directors and Response to Comments Articles will be posted to our website and related to the LCDs when they are posted for notice.
Endovenous Stenting (DL37893)
Hyaluronan Acid Therapies for Osteoarthritis of the Knee (DL35427)
The following JH Local Coverage Determinations (LCDs) have been revised:
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (L35041)
Intravenous Immune Globulin (IVIG) (L35093)
Services That Are Not Reasonable and Necessary (L35094)
The following JH Local Coverage Articles have been revised:
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (A54117)
NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Oncologic Conditions (A53132)
Single Chamber and Dual Chamber Permanent Cardiac Pacemakers – Coding and Billing (A54982)
The comment period will close on November 8, 2018 for the following JH Draft Local Coverage Determinations (LCDs):
Endovenous Stenting (DL37893)
Hyaluronan Acid Therapies for Osteoarthritis of the Knee (DL35427)
Submit Comments
The following JH Local Coverage Determinations (LCDs) have been revised to reflect the Annual ICD-10-CM Code Updates effective for dates of service on and after October 1, 2018.
These LCDs may also contain other updates. Please refer to the revision histories for revision details.
3D Interpretation and Reporting of Imaging Studies (L35408)
Assays for Vitamins and Metabolic Function (L34914)
Bariatric Surgical Management of Morbid Obesity (L35022)
Barium Swallow Studies, Modified (L35433)
Biomarkers Overview (L35062)
Cardiac Rhythm Device Evaluation (L34833)
Chiropractic Services L35424
Controlled Substance Monitoring and Drugs of Abuse Testing (L35006)
Corus® CAD Test (L36713)
C-Reactive Protein High Sensitivity Testing (hsCRP) (L34856)
Intensity Modulated Radiation Therapy (IMRT) (L36711)
Intraoperative Neurophysiological Testing (L35003)
Magnetic Resonance Angiography (MRA) (L34865)
Mohs Micrographic Surgery (MMS) (L34961)
Molecular Diagnostics: Genitourinary Infectious Disease Testing (L35015)
Monitored Anesthesia Care (L35049)
Nerve Conduction Studies and Electromyography (L35081)
Neurophysiology Evoked Potentials (NEPs) (L34975)
Non-Invasive Cerebrovascular Arterial Studies (L35397)
Oximetry Services (L35434)
Psychiatric Codes (L35101)
Pulmonary Function Testing (L35360)
Removal of Benign Skin Lesions (L34938)
Surgery: Blepharoplasty (L35004)
Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography (L35035)
Thrombolytic Agents (L35428)
Transesophageal Echocardiography (TEE) (L35016)
Trigger Point Injections (L35010)
Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic) (L35350)
The following JH Local Coverage Articles have been revised to reflect the Annual ICD-10-CM Code Updates effective for dates of service on and after October 1, 2018.
These articles may also contain other updates. Please refer to the revision histories for revision details.
Ambulance Services (Ground Ambulance) (A54574)
NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions (A53134)
The following JH Local Coverage Article has been revised:
Biomarkers for Oncology (A52986)
The following JH LCD has been retired for dates of service on and after October 25, 2018:
Transoral Incisionless Fundoplication (L34999)
The following JH Local Coverage Determinations have been revised:
Biomarkers for Oncology (L35396)
BRCA1 and BRCA2 Genetic Testing (L36715)
Cardiac Event Detection Monitoring (L34953)
Services That Are Not Reasonable and Necessary (L35094)
The following JH Local Coverage Article has been revised:
Biomarkers for Oncology (A52986)
The following JH Local Coverage Determinations have been retired:
Infrared Photocoagulation (IRC) of Hemorrhoids (L34861)
Oral Maxillofacial Prosthesis (L35047)
Pharmacokinetic (PK) Testing for Chemotherapy Dosing (L35679)
Local Coverage Determinations and Local Coverage Articles affected by the Annual ICD-10 Code Update will be revised and posted to our Website and the Medicare Coverage Database on Thursday, October 25, 2018.
The following JH Draft Local Coverage Determinations (LCDs) have been posted for comment. The comment period will end on November 08, 2018:
Endovenous Stenting (DL37893)
Hyaluronan Acid Therapies for Osteoarthritis of the Knee (DL35427)
Submit Comments
The following JH Local Coverage Determination (LCD) which was posted for notice on July 26, 2018 is now effective:
Nusinersen (Spinraza) (L37682)
The following JH Local Coverage Determinations (LCDs) have been revised:
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (L35041)
Services That Are Not Reasonable and Necessary (L35094)
The following JH Local Coverage Article has been revised:
Independent Diagnostic Testing Facility (IDTF) (A53252)
The following JH Local Coverage Determination (LCD) has been placed on hold and will not become effective on August 16, 2018. Please watch our website for updates regarding this LCD and its effective date.
Facet Joint Interventions for Pain Management (L34892)
The following LCD will remain in effect until further notice:
Facet Joint Injections (L34974)
The following JH Local Coverage Determination (LCD) has been revised:
Debridement of Mycotic Nails (L35013)
The following JH Local Coverage Determinations (LCDs) have been revised:
Ambulance Services (Ground Ambulance) (L35162)
Lower Extremity Major Joint Replacement (Hip and Knee) (L36007)
Luteinizing Hormone-Releasing Hormone (LHRH) Analogs (L34822)
The following JH Draft Local Coverage Determination (LCD) posted for comment on January 18, 2018 and presented at the February 2018 Contractor Advisory Committee (CAC) Meeting has been posted for notice. It will become effective September 14, 2018:
Nusinersen (Spinraza) (L37682)
Comments Received and Contractor Responses
The following JH Local Coverage Determinations (LCDs) have been revised:
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (L35041)
Biomarkers for Oncology (L35396)
Intravenous Immune Globulin (IVIG) (L35093)
The following JH Local Coverage Articles have been revised:
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (A54117)
Biomarkers for Oncology (A52986)
The comment period is now closed for the following JH Draft Local Coverage Determinations (LCDs). Comments received will be reviewed by our Contractor Medical Directors and Response to Comments Articles will be posted to our website and related to the LCDs when they are posted for notice.
DL37792 - 4Kscore Test
DL37796 - Sclerotherapy and Endovenous Non-Thermal Treatment of Varicose Veins
The following JH Local Coverage Determinations (LCDs) have been revised:
Hyaluronan Acid Therapies for Osteoarthritis of the Knee (L35427)
Independent Diagnostic Testing Facility (IDTF) (L35448)
Non-Invasive Peripheral Venous Studies (L35451)
It has come to our attention that the JH Draft LCD Comment Form has not been functioning properly. If you have submitted comments for the following draft LCDs in the past week please resubmit your comment either by:
Email: draftlcdcomments@novitas-solutions.com
or by fax at (717) 728-8767
DL37792 - 4Kscore Test
DL37796 - Sclerotherapy and Endovenous Non-Thermal Treatment of Varicose Veins
The comment period for these two draft LCDs will be extended to July 13, 2018 to allow time for resubmissions and to ensure that adequate time has been provided for comments.
We apologize for any inconvenience this may have caused.
The following JH Draft Local Coverage Determination (LCD) posted for comment on January 18, 2018 and presented at the February 2018 Contractor Advisory Committee (CAC) Meeting has been posted for notice. It will become effective August 16, 2018:
Facet Joint Interventions for Pain Management (L34892)
Comments Received and Contractor Responses
The comment period will close on July 5, 2018 for the following JH Draft Local Coverage Determinations (LCDs):
4Kscore Test (DL37792)
Sclerotherapy and Endovenous Non-Thermal Treatment of Varicose Veins (DL37796)
Submit Comments
The following JH Local Coverage Determinations (LCDs) have been revised:
Cardiac Rhythm Device Evaluation (L34833)
Independent Diagnostic Testing Facility (IDTF) (L35448)
Non-Invasive Cerebrovascular Arterial Studies (L35397)
Non-Vascular Extremity Ultrasound (L35409)
Psychiatric Codes (L35101)
Services That Are Not Reasonable and Necessary (L35094)
The following JH Local Coverage Articles have been revised:
Approved Drugs and Biologicals; Includes Cancer Chemotherapeutic Agents (A53049)
Auricular Peripheral Nerve Stimulation (Electro-Acupuncture Device) (A55240)
The following JH Draft Local Coverage Determinations (LCDs) have been posted for comment. The comment period will end on July 5, 2018:
4Kscore Test (DL37792)
Sclerotherapy and Endovenous Non-Thermal Treatment of Varicose Veins (DL37796)
Submit Comments
The following JH Local Coverage Determinations (LCDs) have been revised:
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (L35041)
C-Reactive Protein High Sensitivity Testing (hsCRP) (L34856)
Diagnostic Abdominal Aortography and Renal Angiography (L35092)
Electroretinography (ERG) (L37371)
Intensity Modulated Radiation Therapy (IMRT) (L36711)
Services That Are Not Reasonable and Necessary (L35094)
The following JH Local Coverage Determinations (LCDs) have been revised:
Hyperbaric Oxygen (HBO) Therapy (L35021)
Intraoperative Neurophysiological Testing (L35003)
Services That Are Not Reasonable and Necessary (L35094)
The following JH Local Coverage Articles have been revised:
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (A54117)
Approved Drugs and Biologicals; Includes Cancer Chemotherapeutic Agents (A53049)
The following JH Local Coverage Determinations (LCDs) have been revised:
Speech - Language Pathology (SLP) Services: Communication Disorders (L35070)
Therapy and Rehabilitation Services (PT, OT) (L35036)
The following JH Local Coverage Article which was posted for notice on January 25, 2018 is now effective:
Self-Administered Drug Exclusion List (A53127)
The comment period is now closed for the following JH Draft Local Coverage Determinations (LCDs). Comments received will be reviewed by our Contractor Medical Directors and Response to Comments Articles will be posted to our website and related to the LCDs when they are posted for notice.
Facet Joint Interventions for Pain Management (DL34892)
Nusinersen (Spinraza) (DL37682)
The following JH Local Coverage Determinations (LCDs) have been revised:
Biomarkers for Oncology (L35396)
Controlled Substance Monitoring and Drugs of Abuse Testing (L35006)
Intravenous Immune Globulin (IVIG) (L35093)
Lacrimal Punctum Plugs (L35095)
Outpatient Sleep Studies (L35050)
Trigger Point Injections (L35010)
Wireless Capsule Endoscopy (L35089)
The following JH Local Coverage Articles have been revised:
Biomarkers for Oncology (A52986)
Independent Diagnostic Testing Facility (IDTF) (A53252)
The comment period will close on March 8, 2018 for the following JH Draft Local Coverage Determinations (LCDs):
Facet Joint Interventions for Pain Management (DL34892)
Nusinersen (Spinraza) (DL37682)
Submit Comments
The following JH Local Coverage Determinations (LCDs) have been revised:
Controlled Substance Monitoring and Drugs of Abuse Testing (L35006)
Frequency of Laboratory Tests (L35099)
Hydration Therapy (L34960)
Intensity Modulated Radiation Therapy (IMRT) (L36711)
Intravenous Immune Globulin (IVIG) (L35093)
Oral Maxillofacial Prosthesis (L35047)
The following JH Local Coverage Determinations (LCDs) have been revised to reflect the Annual CPT/HCPCS Code updates effective for dates of service on and after January 1, 2018:
Allergy Testing (L36241)
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (L35041)
Biomarkers for Oncology (L35396)
Biomarkers Overview (L35062)
BRCA1 and BRCA2 Genetic Testing (L36715)
Controlled Substance Monitoring and Drugs of Abuse Testing (L35006)
Epidural Injections for Pain Management (L36920)
Hemophilia Factor Products (L35111)
Hyaluronan Acid Therapies for Osteoarthritis of the Knee (L35427)
Independent Diagnostic Testing Facility (IDTF) (L35448)
Monitored Anesthesia Care (L35049)
Neurophysiology Evoked Potentials (NEPs) (L34975)
Non-Vascular Extremity Ultrasound (L35409)
Pharmacokinetic (PK) Testing for Chemotherapy Dosing (L35679)
Removal of Benign Skin Lesions (L34938)
Services That Are Not Reasonable and Necessary (L35094)
Speech - Language Pathology (SLP) Services: Communication Disorders (L35070)
Therapy and Rehabilitation Services (PT, OT) (L35036)
Treatment of Varicose Veins and Venous Stasis Disease of the Lower Extremities (L34924)
The following JH Local Coverage Determinations (LCDs) which were posted for notice on December 7, 2017 are now effective:
Electroretinography (ERG) (L37371)
Reflectance Confocal Microscopy (L37375)
Scanning Computerized Ophthalmic Diagnostic Imaging (L35038)
Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography (L35035)
The following JH Local Coverage Articles have been revised to reflect the Annual CPT/HCPCS Code updates effective for dates of service on and after January 1, 2018:
Acute Care: Inpatient, Observation and Treatment Room Services (A52985)
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (A54117)
Billing and Coding for Rezum® Procedure (A55352)
Biomarkers for Oncology (A52986)
Endovascular Repair of Aortic and/or Iliac Aneurysms (A53124)
Hyaluronan Acid Therapies for Osteoarthritis of the Knee (A55036)
Independent Diagnostic Testing Facility (IDTF) (A53252)
NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions (A53134)
NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Oncologic Conditions (A53132)
Non-Vascular Extremity Ultrasound (A55037)
Speech Language Pathology (SLP) Services: Communication Disorders (A54111)
Treatment of Varicose Veins and Venous Stasis Disease of the Lower Extremities (A55229)
The following JH Local Coverage Article has been posted for notice and will become effective March 15, 2018:
Self-Administered Drug Exclusion List (A53127)
The following JH Draft Local Coverage Determinations (LCDs) have been posted for comment. The comment period will end on March 8, 2018:
Facet Joint Interventions for Pain Management (DL34892)
Nusinersen (Spinraza) (DL37682)
Submit Comments
Novitas’ Local Coverage Determinations (LCDs) have a new format. There are three new sections that provide insight into the rationale for the indications and limitations of coverage in Novitas’ LCDs:
1. Summary of Evidence
Contains a summary of the pertinent literature and/or guidelines that were used to determine covered indications and limitations.
2. Analysis of Evidence (Rationale for Determination)
A high level overview and conclusion based on all of the literature and guidelines reviewed.
This section provides the reasoning or basis for the indications and limitations of coverage.
3. Bibliography
A new subsection under the “Sources of Information” that includes all sources used to write the LCD.
The new sections have been added to accommodate the 21st Century Cures Act and will be included in all draft LCDs requiring a comment and notice period. Additionally, when draft LCDs are finalized, Novitas will include a hyperlink at the bottom of the LCD to a “Response to Comments (RTC)” Local Coverage Article that will provide a summary of all the comments received during the draft comment period along with Novitas’ responses. LCDs will continue to be developed and revised in accordance with the CMS Internet-Only Manual (IOM) Publication 100-08, Medicare Program Integrity Manual, Chapter 13.
The new LCD format and RTC Article provide increased clarity and transparency for a better understanding of the development of Local Coverage Determinations.
Novitas is currently reviewing all Local Coverage Determinations (LCDs) and Local Coverage Articles to identify any impact to the documents as a result of the 2018 Annual CPT/HCPCS Code Update. We anticipate posting the revised LCDs and Articles on January 25, 2018.
The following JH Local Coverage Determinations (LCDs) have been revised:
Biomarkers Overview (L35062)
Pulmonary Function Testing (L35360)
Routine Foot Care (L35138)
Vestibular and Audiologic Function Studies (L35007)
The following JH Local Coverage Determination has been retired effective December 1, 2017:
Pain Management of Peripheral Nerves by Injection (L35107)
Clarification Regarding Biomarkers
Novitas considers any biomarker that is not addressed as specifically covered in any of our Local Coverage Determinations (LCDs) or any national policy to be not reasonable and necessary. Although this instruction is included in our Biomarkers for Oncology LCD (L35396), it has been determined that further clarification would be helpful. Therefore, the following statement from the Biomarkers for Oncology LCD is being added to the Novitas’ Biomarkers Overview LCD (L35062): “Biomarkers not addressed in this LCD or any other Novitas LCD will be considered not reasonable and necessary unless specifically covered by national policy.”
The above statement will display in the Biomarkers Overview LCD (L35062) on Novitas’ website and the Medicare Coverage Database (MCD) on December 14, 2017.
The following JH Draft Local Coverage Determination (LCD) posted for comment on January 19, 2017 and presented at the February 2017 Contractor Advisory Committee (CAC) Meeting has been posted for notice. It will become effective January 25, 2018:
Scanning Computerized Ophthalmic Diagnostic Imaging (L35038)
Comments Received and Contractor Responses
The following JH Draft Local Coverage Determinations (LCDs) posted for comment on May 18, 2017 and presented at the June 2017 Contractor Advisory Committee (CAC) Meeting have been posted for notice. They will become effective January 25, 2018:
Electroretinography (ERG) (L37371)
Reflectance Confocal Microscopy (L37375)
Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography (L35035)
Comments Received and Contractor Responses
The following JH Local Coverage Determinations (LCDs) have been revised:
Biomarkers for Oncology (L35396)
Epidural Injections for Pain Management (L36920)
Intravenous Immune Globulin (IVIG) (L35093)
Removal of Benign Skin Lesions (L34938)
Services That Are Not Reasonable and Necessary (L35094)
Spinal Cord Stimulation (Dorsal Column Stimulation) (L35450)
Transoral Incisionless Fundoplication (L34999)
The following JH Local Coverage Article has been revised:
Biomarkers for Oncology (A52986)
The following JH Article has been added:
Wound Care (A53001)
The following JH Local Coverage Determination (LCD) which was posted for notice on September 21, 2017 is now effective:
Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder (L34998)
The following JH Local Coverage Determination (LCD) which was posted for notice on September 21, 2017 has been revised and is now effective:
Wound Care (L35125)
The comment period is now closed for the JH Draft Local Coverage Determination (LCD) listed below. Comments received will be reviewed by our Contractor Medical Directors and a summary comment and response document will be posted to our website when the final LCD is posted for notice.
Frequency of Hemodialysis (DL35014)
The comment period will close on November 2, 2017 for the following JH Draft Local Coverage Determination (LCD):
Frequency of Hemodialysis (DL35014)
Submit Comments
The following JH Article has been added:
Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Physician Requirements (A55758)
The following JH Local Coverage Determinations (LCDs) have been revised to reflect the Annual ICD-10-CM Code Updates effective for dates of service on and after October 1, 2017:
Assays for Vitamins and Metabolic Function (L34914)
Autonomic Function Tests (L35395)
Bariatric Surgical Management of Morbid Obesity (L35022)
Barium Swallow Studies, Modified (L35433)
Biomarkers for Oncology (L35396)
Biomarkers Overview (L35062)
Cardiac Rhythm Device Evaluation (L34833)
Cardiovascular Nuclear Medicine (L35083)
Chiropractic Services (L35424)
Controlled Substance Monitoring and Drugs of Abuse Testing (L35006)
Epidural Injections for Pain Management (L36920)
Facet Joint Injections (L34974)
Flow Cytometry (L35032)
Frequency of Dialysis (L35014)
Frequency of Laboratory Tests (L35099)
Intensity Modulated Radiation Therapy (IMRT) (L36711)
Intraoperative Neurophysiological Testing (L35003)
Intravenous Immune Globulin (IVIG) (L35093)
Magnetic Resonance Angiography (MRA) (L34865)
Monitored Anesthesia Care (L35049)
Nerve Conduction Studies and Electromyography (L35081)
Neuromuscular Junction Testing (L34996)
Neurophysiology Evoked Potentials (NEPs) (L34975)
Non-Invasive Cerebrovascular Arterial Studies (L35397)
Non-Invasive Peripheral Venous Studies (L35451)
Non-Vascular Extremity Ultrasound (L35409)
Oximetry Services (L35434)
Pain Management of Peripheral Nerves by Injection (L35107)
Psychiatric Codes (L35101)
Pulmonary Function Testing (L35360)
Routine Foot Care (L35138)
Scanning Computerized Ophthalmic Diagnostic Imaging (L35038)
Speech - Language Pathology (SLP) Services: Communication Disorders (L35070)
Strapping (L36423)
Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography (L35035)
Thrombolytic Agents (L35428)
Transesophageal Echocardiography (TEE) (L35016)
Treatment of Varicose Veins and Venous Stasis Disease of the Lower Extremities (L34924)
Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic) (L35350)
The following JH Local Coverage Articles have been revised to reflect the Annual ICD-10-CM Code Updates effective for dates of service on and after October 1, 2017:
Ambulance Services (Ground Ambulance) (A54574)
NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions (A53134)
The following JH Local Coverage Determination (LCD) has been revised:
Hyperbaric Oxygen (HBO) Therapy (L35021)
The following JH Local Coverage Article has been revised:
NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Oncologic Conditions (A53132)
Local Coverage Determinations (LCDs) and Local Coverage Articles affected by the Annual ICD-10 Code Update will be revised and posted on the Novitas Website and the Medicare Coverage Database (MCD) on Thursday October 5, 2017.
The following JH Draft Local Coverage Determinations (LCDs) posted for comment on January 19, 2017 and presented at the February 2017 Contractor Advisory Committee (CAC) Meeting have been posted for notice. They will become effective November 9, 2017:
Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder (L34998)
Wound Care (L35125)
Comments Received and Contractor Responses
The following JH LCD is still being finalized and will become effective at a later date. Please continue to watch our website for updates:
Scanning Computerized Ophthalmic Diagnostic Imaging (DL35038)
The following JH LCD is not being finalized. Continue to watch our website for further updates.
Treatment of Varicose Veins of the Lower Extremities (DL34924)
The following JH Local Coverage Determination (LCD) has been revised:
Sacral Nerve Stimulation (L35449)
The following JH Draft Local Coverage Determination (LCD) has been posted for comment. The comment period will end on November 2, 2017.
Frequency of Hemodialysis (DL35014)
Submit Comments
The following JH Local Coverage Article has been added as a companion Article for DL35014, Frequency of Hemodialysis. The Article will become effective at the same time the Final policy becomes effective.
Frequency of Hemodialysis (A55723)
The following JH Local Coverage Article has been revised:
Approved Drugs and Biologicals; Includes Cancer Chemotherapeutic Agents (A53049)
The following JH Local Coverage Article which was posted for notice on July 13, 2017 is now effective:
Self-Administered Drug Exclusion List (A53127)
The following JH Local Coverage Determination (LCD) has been revised:
Services that Are Not Reasonable and Necessary (L35094)
The following JH Local Coverage Determinations (LCDs) have been revised;
Allergy Testing (L36241)
Barium Swallow Studies, Modified (L35433)
Biomarkers for Oncology (L35396)
Cataract Extraction (including Complex Cataract Surgery) (L35091)
Hyaluronan Acid Therapies for Osteoarthritis of the Knee (L35427)
Implantable Infusion Pump (L35112)
Independent Diagnostic Testing Facility (IDTF) (L35448)
Intensity Modulated Radiation Therapy (IMRT) (L36711)
Intravenous Immune Globulin (IVIG) (L35093)
Magnetic Resonance Angiography (MRA) (L34865)
Services That Are Not Reasonable and Necessary (L35094)
The following JH Local Coverage Article has been revised:
Biomarkers for Oncology (A52986)
The following JH Local Coverage Article has been revised:
Ventricular Assist Device (VAD) Supply or Accessory (A54910)
The following JH Local Coverage Article has been retired:
Capsaicin Patch (A53122)
The following JH Local Coverage Determinations (LCDs) have been revised:
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (L35041)
Bariatric Surgical Management of Morbid Obesity (L35022)
Biomarkers for Oncology (L35396)
Cardiovascular Nuclear Medicine (L35083)
Psychiatric Codes (L35101)
Removal of Benign Skin Lesions (L34938)
The following JH Local Coverage Determination (LCD) has been retired effective July 13, 2017:
Coverage of Services and Procedures in Nursing Facilities (L34863)
The following JH Local Coverage Article has been revised:
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (A54117)
The following JH Local Coverage Article has been Posted for Notice and will become effective August 28, 2017:
Self-Administered Drug Exclusion List (A53127)
The comment period is now closed for the JH Draft Local Coverage Determinations (LCDs) listed below. Comments received will be reviewed by our Contractor Medical Directors and a summary comment and response document will be posted to our website when the final LCDs are posted for notice.
Electroretinography (ERG) (DL37371)
Reflectance Confocal Microscopy (DL37375)
Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography (DL35035)
The following JH Local Coverage Determination (LCD) has been revised and is now displaying properly:
Epidural Injections for Pain Management (L36920)
The following JH Local Coverage Determination (LCD) has been revised:
Services That Are Not Reasonable and Necessary (L35094)
The comment period will close on July 6, 2017 for the following JH Draft Local Coverage Determinations (LCDs):
Electroretinography (ERG) (DL37371)
Reflectance Confocal Microscopy (DL37375)
Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography (DL35035)
Submit Comments
Epidural Injections for Pain Management (L36920)
It has been brought to our attention that LCD L36920, Epidural Injections for Pain Management is displaying incorrectly indicating that the policy is on hold. Please be advised that as communicated on June 8, 2017, L36920, Epidural Injections for Pain Management is effective and became effective June 8, 2017.
We apologize for any confusion that this may have caused and we are diligently working to have the notification on the LCD corrected as soon as possible. Please continue to watch our website for updates.
LCD L36711 – Intensity Modulated Radiation Therapy (IMRT)
Following review and discussion of L36711 Novitas will be making revisions to the policy. Please continue to watch our website.
As a reminder, the LCD Reconsideration Process is the appropriate mechanism for interested parties to request a revision to a LCD. The process is available only for final LCDs. The whole LCD or any provision of the LCD may be reconsidered. Any requests for revisions to LCD L36711 must be submitted via this process.
LCD Reconsideration Process Instructions
It has come to our attention that the Draft Local Coverage Determinations (LCDs) Submit Comments form has not been functioning properly. Your comments are important to us; therefore, if you submitted comments for the following draft LCDs using the form and did not receive an email acknowledging receipt of your comments, we encourage you to re-submit your comments. We apologize for any inconvenience.
Electroretinography (ERG) (DL37371)
Reflectance Confocal Microscopy (DL37375)
Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography (DL35035)
Submit Comments
The following JH Local Coverage Determinations (LCDs) have been revised:
Cosmetic and Reconstructive Surgery (L35090)
Lower Extremity Major Joint Replacement (Hip and Knee) (L36007)
Outpatient Wireless Pulmonary Artery Pressure Monitoring for Heart Failure (L36419)
Removal of Benign Skin Lesions (L34938)
The following JH Draft LCD which was posted for comment on December 8, 2016 is retired and will not be finalized at this time.
Radiation Therapy for T1 Basal Cell and Squamous Cell Carcinoma of the Skin (DL36999)
The following JH Local Coverage Article has been revised:
Biomarkers for Oncology (A52986)
The hold that was placed on the following LCD on April 27, 2017 has been lifted and the LCD is effective as of June 8, 2017:
Epidural Injections for Pain Management (L36920)
Open Comment Period for Draft Policies
Novitas Solutions recently posted the following draft Local Coverage Determinations (LCDs) for public comment. This is an important opportunity to provide feedback on any aspect of the draft policies.
Under each draft LCD, the specialties listed may have a particular interest in the policies. Please take the time to read the drafts and comment before July 6, 2017.
Electroretinography (ERG) (DL37371):
Ophthalmologist
Optometrist
Neurology
Reflectance Confocal Microscopy (DL37375):
Dermatology
Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography (DL35035):
Nephrology
Diagnostic Radiology
Interventional Radiology
Cardiology
Interventional Cardiology
General Surgery
Cardiac Surgery
Vascular Surgery
Neurology
Neurosurgery
Internal Medicine
Submit Comments
The following JH Draft Local Coverage Determinations (LCDs) have been posted for comment. The comment period will end on July 6, 2017.
Electroretinography (ERG) (DL37371)
Reflectance Confocal Microscopy (DL37375)
Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography (DL35035)
Submit Comments
The following JH Local Coverage Determinations (LCDs) have been revised:
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (L35041)
Biomarkers for Oncology (L35396)
Biomarkers Overview (L35062)
Blood Glucose Monitoring in a Skilled Nursing Facility (SNF) (L34834)
Cardiac Rhythm Device Evaluation (L34833)
Non-Vascular Extremity Ultrasound (L35409)
Scanning Computerized Ophthalmic Diagnostic Imaging (L35038)
Thrombolytic Agents (L35428)
The following JH Local Coverage Articles have been revised:
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (A54117)
Biomarkers for Oncology (A52986)
Prolonged Drug and Biological Infusions Started Incident To a Physician’s Service Using an External Pump (A55134)
The following JH Local Coverage Determinations (LCDs) have been revised:
Allergy Testing (L36241)
Services That Are Not Reasonable and Necessary (L35094)
The following JH Local Coverage Determination (LCD) which was posted for notice on March 16, 2017 is now effective:
Vertebroplasty, Vertebral Augmentation (Kyphoplasty) Percutaneous (L35130)
The following JH LCD has been revised and placed on hold and will not become effective May 4, 2017. Please continue to watch our website for updates:
Epidural Injections for Pain Management (L36920)
The following JH Local Coverage Determinations have been revised:
Assays for Vitamins and Metabolic Function (L34914)
Autonomic Function Tests (L35395)
Diagnostic Abdominal Aortography and Renal Angiography (L35092)
Independent Diagnostic Testing Facility (IDTF) (L35448)
Intravenous Immune Globulin (IVIG) (L35093)
Speech - Language Pathology (SLP) Services: Communication Disorders (L35070)
The following JH Local Coverage Articles have been revised:
Independent Diagnostic Testing Facility (IDTF) (A53252)
NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Oncologic Conditions (A53132)
The following JH Local Coverage Determinations have been revised:
Ambulance Services (Ground Ambulance) (L35162)
Biomarkers Overview (L35062)
Services That Are Not Reasonable and Necessary (L35094)
The following JH Local Coverage Article has been revised:
Billing and Coding for Rezum® Procedure (A55352)
The following JH Local Coverage Determination (LCD) posted for notice on December 8, 2016 became effective February 1, 2017:
Removal of Benign Skin Lesions (L34938)
The following JH LCD has been retired effective January 31, 2017:
Benign Skin Lesions (L34966)
The following JH LCD has been retired effective February 1, 2017:
Pain Management (L35033)
The following JH Draft Local Coverage Determinations (LCDs) posted for comment on September 15, 2016 and presented at the October 2016 Contractor Advisory Committee (CAC) Meeting have been posted for notice. They will become effective May 4, 2017:
Epidural Injections for Pain Management (L36920)
Vertebroplasty, Vertebral Augmentation (Kyphoplasty) Percutaneous (L35130)
Comments Received and Contractor Responses
The comment period is now closed for the JH Draft Local Coverage Determinations (LCDs) listed below. Comments received will be reviewed by our Contractor Medical Directors and a summary comment and response document will be posted to our website when the final LCDs are posted for notice.
Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder (DL34998)
Scanning Computerized Ophthalmic Diagnostic Imaging (DL35038)
Treatment of Varicose Veins of the Lower Extremities (DL34924)
Wound Care (DL35125)
The comment period will close on March 9, 2017 for the following JH Draft Local Coverage Determinations (LCDs):
Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder (DL34998)
Scanning Computerized Ophthalmic Diagnostic Imaging (DL35038)
Treatment of Varicose Veins of the Lower Extremities (DL34924)
Wound Care (DL35125)
Submit Comments
The comment period is now closed for the JH Draft Local Coverage Determination (LCD) listed below. Comments received will be reviewed by our Contractor Medical Directors and a summary comment and response document will be posted to our website when the final LCD is posted for notice.
Radiation Therapy for T1 Basal Cell and Squamous Cell Carcinoma of the Skin (DL36999)
Novitas Solutions recently posted the following draft Local Coverage Determinations (LCDs) for public comment. This is an important opportunity to provide feedback on any aspect of the draft policies.
Under each draft LCD, the specialties listed may have a particular interest in the policies. Please take the time to read the drafts and comment before March 9, 2017.
Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder (DL34998)
Pain Management
Family Practice
Neurology
Scanning Computerized Ophthalmic Diagnostic Imaging (DL35038)
Ophthalmology
Optometrist
Treatment of Varicose Veins of the Lower Extremities (DL34924)
Emergency Medicine
Cardiology
Obstetrics/Gynecology
Diagnostic Radiology
Interventional Radiology
Family Practice
General Practice
Interventional Cardiology
Thoracic Surgery
Anesthesiology
Wound Care (DL35125)
Dermatology
General Surgery
Family Practice
Vascular Surgery
Internal Medicine
Infectious Disease
Orthopedic Surgery
Sports Medicine
Plastic and Reconstructive Surgery
Emergency Medicine
Submit Comments
Novitas has decided to extend the comment period for the following JH Draft Local Coverage Determination (LCD) which was posted for a second comment period on December 8, 2016. The comment period will now end on February 28, 2017.
Radiation Therapy for T1 Basal Cell and Squamous Cell Carcinoma of the Skin (DL36999)
Submit comments
The following JH Draft Local Coverage Determinations (LCDs) are posted for comment. The comment period will end on March 9, 2017.
Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder (DL34998)
Scanning Computerized Ophthalmic Diagnostic Imaging (DL35038)
Treatment of Varicose Veins of the Lower Extremities (DL34924)
Wound Care (DL35125)
Submit Comments
The following JH Local Coverage Determinations (LCDs) have been revised to reflect the Annual CPT/HCPCS Code updates effective for dates of service on and after January 1, 2017:
Allergy Testing (L36241)
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (L35041)
Biomarkers for Oncology (L35396)
Biomarkers Overview (L35062)
Controlled Substance Monitoring and Drugs of Abuse Testing (L35006)
Hemophilia Factor Products (L35111)
Hyaluronan Acid Therapies for Osteoarthritis of the Knee (L35427)
Independent Diagnostic Testing Facility (IDTF) (L35448)
Non-Coronary Vascular Stents (L35084)
Non-Invasive Cerebrovascular Arterial Studies (L35397)
Non-Invasive Peripheral Venous Studies (L35451)
Psychiatric Codes (L35101)
Services That Are Not Reasonable and Necessary (L35094)
Surgical Treatment of Nails (L34887)
Therapy and Rehabilitation Services (PT, OT) (L35036)
Thrombolytic Agents (L35428)
Treatment of Varicose Veins and Venous Stasis Disease of the Lower Extremities (L34924)
The following JH LCDs have been revised:
Bariatric Surgical Management of Morbid Obesity (L35022)
Diagnostic Abdominal Aortography and Renal Angiography (L35092)
Pain Management of Peripheral Nerves by Injection (L35107)
Surgery: Posterior Tibial Nerve Stimulation (PTNS) for Urinary Control (L35011)
The following JH Local Coverage Determination has been retired effective December 31, 2016:
Vascular Access for Hemodialysis (L35064)
The following LCD is currently being reviewed. Revisions will be forthcoming. Please continue to watch our website.
Pain Management (L35033)
The following JH Local Coverage Articles have been revised to reflect the Annual CPT/HCPCS code updates effective for dates of service on and after January 1, 2017:
Acute Care: Inpatient, Observation and Treatment Room Services (A52985)
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (A54117)
Biomarkers for Oncology (A52986)
Hyaluronan Acid Therapies for Osteoarthritis of the Knee (A55036)
Independent Diagnostic Testing Facility (IDTF) (A53252)
NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions (A53134)
NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Oncologic Conditions (A53132)
Non-Invasive Peripheral Venous Studies (A52993)
Prolonged Drug and Biological Infusions Started Incident To a Physician’s Service Using an External Pump (A55134)
Surgical Treatment of Nails (A52998)
Treatment of Varicose Veins and Venous Stasis Disease of the Lower Extremities (A55229)
The following JH Local Coverage Articles have been revised:
Approved Drugs and Biologicals; Includes Cancer Chemotherapeutic Agents (A53049)
Thrombolytic Agents (A55237)
The following JH Draft Local Coverage Determination (LCD) posted for comment on March 3, 2016 and September 17, 2015 and presented at the October 2015 Contractor Advisory Committee (CAC) Meeting has been posted for notice. It will become effective February 1, 2017.
Removal of Benign Skin Lesions (L34938)
Comments Received and Contractor Responses
In response to comments that were received during the initial comment period (May 19, 2016 – July 7, 2016), the following JH Draft Local Coverage Determination (LCD) has undergone additional revisions and is being posted for another comment period. Due to system limitations, the draft has been assigned a new DL number. The comment period will end on January 30, 2017.
Radiation Therapy for T1 Basal Cell and Squamous Cell Carcinoma of the Skin (DL36999)
Submit comments
The following JH Draft Local Coverage Determination (LCD) which was posted for comment on May 19, 2016 will not be finalized due to revisions based on comments received and has been retired effective December 7, 2016. Please refer to DL36999 above posted for comment on December 8, 2016.
Radiation Therapy for T1 Basal Cell and Squamous Cell Carcinoma of the Skin (DL36747)
The following JH Local Coverage Determinations (LCDs) have been revised:
Diagnostic Abdominal Aortography and Renal Angiography (L35092)
Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography (L35035)
The following JH Local Coverage Determinations (LCDs) which were posted for notice on October 13, 2016 are now effective:
Biomarkers for Oncology (L35396)
Biomarkers Overview (L35062)
BRCA1 and BRCA2 Genetic Testing (L36715)
Corus® CAD Test (L36713)
Intensity Modulated Radiation Therapy (IMRT) (L36711)
Non-Invasive Cerebrovascular Arterial Studies (L35397)
Non-Invasive Peripheral Venous Studies (L35451)
The following JH Local Coverage Articles have been revised:
Biomarkers for Oncology (A52986)
Non-Invasive Cerebrovascular Arterial Studies (A52992)
Non-Invasive Peripheral Venous Studies (A52993)
The following JH Local Coverage Determinations (LCDs) have been revised:
Flow Cytometry (L35032)
Hemophilia Factor Products (L35111)
Scanning Computerized Ophthalmic Diagnostic Imaging (L35038)
Services That Are Not Reasonable and Necessary (L35094)
Thrombolytic Agents (L35428)
The following JH Local Coverage Article has been added:
Billing and Coding for Rezum® Procedure (A55352)
The following JH Local Coverage Article has been revised:
Independent Diagnostic Testing Facility (IDTF) (A53252)
The comment period is now closed for the JH Draft Local Coverage Determinations (LCDs) listed below. Comments received will be reviewed by our Contractor Medical Directors and a summary comment and response document will be posted to our website when the final LCDs are posted for notice.
Epidural Injections for Pain Management (DL36920)
Vascular Access for Hemodialysis (DL35064)
Vertebroplasty, Vertebral Augmentation (Kyphoplasty) Percutaneous (DL35130)
The comment period will close on November 3, 2016 for the following JH Draft Local Coverage Determinations (LCDs):
Epidural Injections for Pain Management (DL36920)
Vascular Access for Hemodialysis (DL35064)
Vertebroplasty, Vertebral Augmentation (Kyphoplasty) Percutaneous (DL35130)
The following JH Local Coverage Article which was posted for notice on September 8, 2016 is now effective:
Self-Administered Drug Exclusion List (A53127)
The following JH Local Coverage Determinations have been revised:
Assays for Vitamins and Metabolic Function (L34914)
Hyperbaric Oxygen (HBO) Therapy (L35021)
Services That Are Not Reasonable and Necessary (L35094)
Spinal Cord Stimulation (Dorsal Column Stimulation) (L35450)
Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic) (L35350)
The following JH Local Coverage Articles have been revised:
Biomarkers for Oncology (A52986)
Prolonged Drug and Biological Infusions Started Incident To a Physician’s Service Using an External Pump (A55134)
The following JH Draft Local Coverage Determinations (LCDs) posted for comment on May 19, 2016 and presented at the June 2016 Contractor Advisory Committee (CAC) Meeting have been posted for notice. They will become effective December 1, 2016:
Biomarkers for Oncology (L35396)
Biomarkers Overview (L35062)
BRCA1 and BRCA2 Genetic Testing (L36715)
Corus® CAD Test (L36713)
Intensity Modulated Radiation Therapy (IMRT) (L36711)
Non-Invasive Cerebrovascular Arterial Studies (L35397)
Non-Invasive Peripheral Venous Studies (L35451)
Comments Received and Contractor Responses
The following JH Draft Local Coverage Determination (LCD) is not being finalized at this time. Please continue to watch our website for further updates:
Radiation Therapy for T1 Basal Cell and Squamous Cell Carcinoma of the Skin (DL36747)
The following JH Local Coverage Determinations (LCDs) have been revised to reflect the Annual ICD-10-CM Code Updates effective for dates of service on and after October 1, 2016:
3D Interpretation and Reporting of Imaging Studies (L35408)
Anorectal Manometry, Anal Electromyography, and Biofeedback Training for Perineal Muscles and Anorectal or Urethral Sphincters (L34977)
Assays for Vitamins and Metabolic Function (L34914)
Autonomic Function Tests (L35395)
Bariatric Surgical Management of Morbid Obesity (L35022)
Barium Swallow Studies, Modified (L35433)
Biomarkers for Oncology (L35396)
Cardiac Rhythm Device Evaluation (L34833)
Cardiovascular Nuclear Medicine (L35083)
Chiropractic Services (L35424)
Controlled Substance Monitoring and Drugs of Abuse Testing (L35006)
C-Reactive Protein High Sensitivity Testing (hsCRP) (L34856)
Diagnostic Abdominal Aortography and Renal Angiography (L35092)
Facet Joint Injections (L34974)
Flow Cytometry (L35032)
Frequency of Laboratory Tests (L35099)
Hydration Therapy (L34960)
Intraoperative Neurophysiological Testing( L35003)
Lower Extremity Major Joint Replacement (Hip and Knee) (L36007)
Magnetic Resonance Angiography (MRA) (L34865)
Molecular Diagnostics: Genitourinary Infectious Disease Testing (L35015)
Monitored Anesthesia Care (L35049)
Nerve Conduction Studies and Electromyography (L35081)
Neuromuscular Junction Testing (L34996)
Neurophysiology Evoked Potentials (NEPs) (L34975)
Non-Coronary Vascular Stents (L35084)
Non-Invasive Cerebrovascular Arterial Studies (L35397)
Non-Invasive Peripheral Venous Studies (L35451)
Non-Vascular Extremity Ultrasound (L35409)
Outpatient Sleep Studies (L35050)
Oximetry Services (L35434)
Pain Management (L35033)
Prostate Mapping Biopsy (L35009)
Psychiatric Codes (L35101)
Pulmonary Function Testing (L35360)
Routine Foot Care (L35138)
Scanning Computerized Ophthalmic Diagnostic Imaging (L35038)
Speech - Language Pathology (SLP) Services: Communication Disorders (L35070)
Spinal Cord Stimulation (Dorsal Column Stimulation) (L35450)
Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography (L35035)
Thrombolytic Agents (L35428)
Transesophageal Echocardiography (TEE) (L35016)
Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic) (L35350)
Vascular Access for Hemodialysis (L35064)
Vestibular and Audiologic Function Studies (L35007)
Wireless Capsule Endoscopy (L35089)
The following JH Local Coverage Determination (LCD) has been revised to reflect the Annual ICD-10-CM Code Updates effective for dates of service on and after October 1, 2016 and has also been revised due to an inquiry. Please refer to the Revision History Explanation for specific information:
Biomarkers Overview (L35062)
The following JH Local Coverage Articles have been revised to reflect the Annual ICD-10-CM Code Updates effective for dates of service on and after October 1, 2016:
Ambulance Services (Ground Ambulance) (A54574)
NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions (A53134)
The following JH Draft Local Coverage Determinations (LCDs) are posted for comment. The comment period ends on November 3, 2016
Epidural Injections for Pain Management (DL36920)
Vascular Access for Hemodialysis (DL35064)
Vertebroplasty, Vertebral Augmentation (Kyphoplasty) Percutaneous (DL35130)
The following JH Draft Local Coverage Determination (LCD) which was posted for comment on January 22, 2016 will not be finalized and has been retired effective June 1, 2016. Please refer to DL36920 posted for comment on September 15, 2016.
Lumbar Epidural Injections for Pain Management (DL34892)
The following JH Local Coverage Determinations (LCDs) have been revised:
Allergy Testing (L36241)
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (L35041)
Therapy and Rehabilitation Services (PT, OT) (L35036)
The following JH Local Coverage Article has been revised. The revisions will become effective October 24, 2016:
Self-Administered Drug Exclusion List (A53127)
The following JH Local Coverage Determinations (LCDs) have been revised:
3D Interpretation and Reporting of Imaging Studies (L35408)
Allergen Immunotherapy (L36240)
Flow Cytometry (L35032)
Services That Are Not Reasonable and Necessary (L35094)
Wound Care (L35125)
The following JH Local Coverage Determinations (LCDs) have been retired effective August 11, 2016:
Glaucoma Treatment with Aqueous Drainage Device (L35087)
Magnetic Pelvic Floor Stimulation (MPFS) (L35390)
The following JH Local Coverage Article has been revised:
Independent Diagnostic Testing Facility (IDTF) (A53252)
The following JH Local Coverage Articles have been added:
Auricular Peripheral Nerve Stimulation (Electro-Acupuncture Device) (A55240)
Treatment of Varicose Veins and Venous Stasis Disease of the Lower Extremities (A55229)
The following JH Local Coverage Determinations (LCDs) which were posted for notice on June 16, 2016 have been revised and are now effective:
Assays for Vitamins and Metabolic Function (L34914)
Diagnostic Abdominal Aortography and Renal Angiography (L35092)
Pulmonary Function Testing (L35360)
Thrombolytic Agents (L35428)
The following JH Local Coverage Determination (LCD) which was posted for notice on June 16, 2016 is now effective:
Non-Vascular Extremity Ultrasound (L35409)
The following JH Local Coverage Determinations (LCDs) have been revised:
Vascular Access for Hemodialysis (L35064)
Hyperbaric Oxygen (HBO) Therapy (L35021)
The following JH Local Coverage Article has been added:
Thrombolytic Agents (A55237)
July 14, 2016
The following JH Local Coverage Determinations have been revised:
Ambulance Services (Ground Ambulance) (L35162)
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (L35041)
Hyperbaric Oxygen (HBO) Therapy (L35021)
Independent Diagnostic Testing Facility (IDTF) (L35448)
Loss-of-Heterozygosity Based Topographic Genotyping with PathfinderTG ® (L34864)
Monitored Anesthesia Care (L35049)
Non-Invasive Cerebrovascular Arterial Studies (L35397)
Sacral Nerve Stimulation (L35449)
Services That Are Not Reasonable and Necessary (L35094)
The following JH Local Coverage Articles have been revised:
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (A54117)
Independent Diagnostic Testing Facility (IDTF) (A53252)
NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions (A53134)
The following JH Local Coverage Article has been added:
Prolonged Drug and Biological Infusions Started Incident To a Physician’s Service Using an External Pump (A55134)
The following JH Local Coverage Article is now effective:
Billing and Coding Information Regarding Uses, Including Off-Label Uses, of Anti-Vascular Endothelial Growth Factor (anti-VEGF), for The Treatment of Ophthalmological Diseases (A53121)
The comment period is now closed for the JH Draft Local Coverage Determinations (LCDs) listed below. Comments received will be reviewed by our Contractor Medical Directors and a summary comment and response document will be posted to our website when the final LCDs are posted for notice.
Biomarkers for Oncology (DL35396)
Biomarkers Overview (DL35062)
BRCA1 and BRCA2 Genetic Testing (DL36715)
Corus® CAD Test (DL36713)
Intensity Modulated Radiation Therapy (IMRT) (DL36711)
Non-Invasive Cerebrovascular Arterial Studies (DL35397)
Non-Invasive Peripheral Venous Studies (DL35451)
Radiation Therapy for T1 Basal Cell and Squamous Cell Carcinoma of the Skin (DL36747)
The comment period will close on July 7, 2016 for the following JH Draft Local Coverage Determinations (LCDs):
Biomarkers for Oncology (DL35396)
Biomarkers Overview (DL35062)
BRCA1 and BRCA2 Genetic Testing (DL36715)
Corus® CAD Test (DL36713)
Intensity Modulated Radiation Therapy (IMRT) (DL36711)
Non-Invasive Cerebrovascular Arterial Studies (DL35397)
Non-Invasive Peripheral Venous Studies (DL35451)
Radiation Therapy for T1 Basal Cell and Squamous Cell Carcinoma of the Skin (DL36747)
Submit Comments
The following JH Draft Local Coverage Determinations (LCDs) posted for comment on January 22, 2016 and presented at the February 2016 Contractor Advisory Committee (CAC) Meeting have been posted for notice. They will become effective August 4, 2016:
Assays for Vitamins and Metabolic Function (L34914)
Diagnostic Abdominal Aortography and Renal Angiography (L35092)
Non-Vascular Extremity Ultrasound (L35409)
Pulmonary Function Testing (L35360)
Thrombolytic Agents (L35428)
Comments Received and Contractor Responses
The following JH Draft Local Coverage Determination (LCD) is not being finalized at this time. Please continue to watch our website for further updates:
Lumbar Epidural Injections for Pain Management (DL34892)
The following JH Local Coverage Determinations have been revised:
Psychiatric Codes (L35101)
Services That Are Not Reasonable and Necessary (L35094)
Therapy and Rehabilitation Services (PT, OT) (L35036)
Vestibular and Audiologic Function Studies (L35007)
The following JH Local Coverage Article has been revised:
Biomarkers for Oncology (A52986)
The following JH Local Coverage Article has been added with a future effective date of July 11, 2016:
Billing and Coding Information Regarding Uses, Including Off-Label Uses, of Anti-Vascular Endothelial Growth Factor (anti-VEGF), for The Treatment of Ophthalmological Diseases (A53121) (Effective 7/11/2016)
The following JH Provider Bulletin has been added:
Reminder Regarding Ambulance Transports – Dual Diagnoses (Provider Bulletin) (A55096)
The following JH Local Coverage Determination has been revised:
Hyperbaric Oxygen (HBO) Therapy (L35021)
The following JH Draft Local Coverage Determination has been retired effective May 19, 2016:
4KScore Prostate Cancer Test (DL36736)
The following JH Draft Local Coverage Determinations (LCDs) are posted for comment. The comment period ends on July 7, 2016.
Biomarkers for Oncology (DL35396)
Biomarkers Overview (DL35062)
BRCA1 and BRCA2 Genetic Testing (DL36715)
Corus® CAD Test (DL36713)
Intensity Modulated Radiation Therapy (IMRT) (DL36711)
Non-Invasive Cerebrovascular Arterial Studies (DL35397)
Non-Invasive Peripheral Venous Studies (DL35451)
Radiation Therapy for T1 Basal Cell and Squamous Cell Carcinoma of the Skin (DL36747)
4KScore Prostate Cancer Test (DL36736)
Submit Comments
The following JH Local Coverage Determination has been revised:
Hyperbaric Oxygen (HBO) Therapy (L35021)
The following JH Local Coverage Determinations (LCDs) have been revised:
Allergy Testing (L36241)
Autonomic Function Tests (L35395)
Cataract Extraction (including Complex Cataract Surgery) (L35091)
Hemophilia Factor Products (L35111)
Hyaluronan Acid Therapies for Osteoarthritis of the Knee (L35427)
Hydration Therapy (L34960)
Independent Diagnostic Testing Facility (IDTF) (L35448)
Intravenous Immune Globulin (IVIG) (L35093)
Lower Extremity Major Joint Replacement (Hip and Knee) (L36007)
Psychiatric Codes (L35101)
Services That Are Not Reasonable and Necessary (L35094)
The following JH Local Coverage Articles have been revised:
Acute Care: Inpatient, Observation and Treatment Room Services (A52985)
Independent Diagnostic Testing Facility (IDTF) (A53252)
The following JH Local Coverage Articles have been added:
Autonomic Function Test (A54954)
Hyaluronan Acid Therapies for Osteoarthritis of the Knee (A55036)
Non-Vascular Extremity Ultrasound (A55037)
The following JH Local Coverage Article became effective on May 1, 2016:
Single Chamber and Dual Chamber Permanent Cardiac Pacemakers - Coding and Billing (A54982)
The comment period is now closed for the following JH Draft Local Coverage Determination (LCD):
Removal of Benign Skin Lesions (DL34938)
The following JH Local Coverage Determinations (LCDs) have been revised:
Neurophysiology Evoked Potentials (NEPs) (L34975)
Therapy and Rehabilitation Services (PT, OT) (L35036)
The following JH ICD-10 Local Coverage Determinations have been revised:
Allergen Immunotherapy (L36240)
Allergy Testing (L36241)
Assays for Vitamins and Metabolic Function (L34914)
Biomarkers for Oncology (L35396)
Diagnostic Abdominal Aortography and Renal Angiography (L35092)
Glaucoma Treatment with Aqueous Drainage Device (L35087)
Hemophilia Factor Products (L35111)
Lower Extremity Major Joint Replacement (Hip and Knee) (L36007)
Non-Coronary Vascular Stents (L35084)
Psychiatric Codes (L35101)
Speech - Language Pathology (SLP) Services: Communication Disorders (L35070)
Surgical Treatment of Nails (L34887)
Vestibular and Audiologic Function Studies (L35007)
The following JH Local Coverage Article has been added and will become effective May 1, 2016:
Single Chamber and Dual Chamber Permanent Cardiac Pacemakers - Coding and Billing (A54982)
The comment period will close on April 21, 2016 for the following JH Draft Local Coverage Determination (LCD):
Removal of Benign Skin Lesions (DL34938)
Looking for retired Local Coverage Determinations (LCDs) or retired Local Coverage Articles?
Links to the retired LCDs and retired Articles have been added to our Medical Policy Center home page. If you are looking for an LCD or Article that was retired on September 30, 2015 or after please follow the links below. If you are looking for an LCD or Article that was retired prior to September 30, 2015 please visit the MCD Archive Site at MCD Archive Site.
Retired LCDs
Retired Local Coverage Articles
The following JH Local Coverage Determination (LCD) which was posted for notice on February 25, 2016 is now effective:
In Vitro Chemosensitivity & Chemoresistance Assays (L36634)
The following JH Local Coverage Determinations (LCDs) which were posted for notice on February 19, 2016 are now effective:
Autonomic Function Tests (L35395)
C-Reactive Protein High Sensitivity Testing (hsCRP) (L34856)
Frequency of Laboratory Tests (L35099)
Microvascular Therapy (L36434)
Outpatient Wireless Pulmonary Artery Pressure Monitoring for Heart Failure (L36419)
Strapping (L36423)
The following JH Local Coverage Determinations (LCDs) which were posted for notice on February 19, 2016 have been revised and are now effective:
Neurophysiology Evoked Potentials (NEPs) (L34975)
Therapy and Rehabilitation Services (PT, OT) (L35036)
Comments received during the comment period are still being considered for the following JH Draft LCDs. Please continue to watch our website for further updates:
Facet Joint Injections (DL34974)
Nerve Blockade for Treatment of Chronic Pain and Neuropathy (DL35033)
The following JH Local Coverage Articles have been revised:
Independent Diagnostic Testing Facility (IDTF) (A53252)
Microvascular Therapy (MVT) (A54343)
The following JH Local Coverage Determinations have been revised:
Nerve Conduction Studies and Electromyography (L35081)
Services That Are Not Reasonable and Necessary (L35094)
The following JH Local Coverage Article which was posted for notice on January 28, 2016 is now effective:
Self-Administered Drug Exclusion List (A53127)
The comment period is now closed for the following JH Draft Local Coverage Determinations (LCDs):
Assays for Vitamins and Metabolic Function (DL34914)
Diagnostic Abdominal Aortography and Renal Angiography (DL35092)
Lumbar Epidural Injections for Pain Management (DL34892)
Non-Vascular Extremity Ultrasound (DL35409)
Pulmonary Function Testing (DL35360)
Thrombolytic Agents (DL35428)
The following JH Local Coverage Determinations have been revised:
Benign Skin Lesions (L34966)
Cardiovascular Nuclear Medicine (L35083)
Intraoperative Neurophysiological Testing (L35003)
Intravenous Immune Globulin (IVIG) (L35093)
Loss-of-Heterozygosity Based Topographic Genotyping with PathfinderTG® (L34864)
Medicine: Neurophysiology Evoked Potentials (NEPs) (L34975)
Non-Invasive Cerebrovascular Arterial Studies (L35397)
Pain Management (L35033)
Therapy Services (PT, OT, SLP) (L35036)
The following JH Local Coverage Article has been revised:
NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions (A53134)
In response to comments that were received during the initial comment period (September 17, 2015 - November 5, 2015), the following JH Draft Local Coverage Determination (LCD) has undergone additional revisions and is being posted for another comment period. The comment period will end on April 21, 2016:
Removal of Benign Skin Lesions (DL34938)
The current comment period will close on March 10, 2016 for the following JH Draft Local Coverage Determinations (LCDs):
Assays for Vitamins and Metabolic Function (DL34914)
Diagnostic Abdominal Aortography and Renal Angiography (DL35092)
Lumbar Epidural Injections for Pain Management (DL34892)
Non-Vascular Extremity Ultrasound (DL35409)
Pulmonary Function Testing (DL35360)
Thrombolytic Agents (DL35428)
Submit comments
The following JH Local Coverage Determination (LCD) is the final version of L36055 that was posted for notice on November 5, 2015 and placed on hold on December 31, 2015. The policy has been assigned the new LCD number indicated below and is posted for notice. It will become effective on April 11, 2016.
In Vitro Chemosensitivity & Chemoresistance Assays (L36634)
The following JH Draft Local Coverage Determinations (LCDs) posted for comment on September 17, 2015 and presented at the October 2015 Contractor Advisory Committee (CAC) Meeting have been posted for notice. They will become effective April 7, 2016:
Autonomic Function Tests (L35395)
C-Reactive Protein High Sensitivity Testing (hsCRP) (L34856)
Frequency of Laboratory Tests (L35099)
Microvascular Therapy (L36434)
Neurophysiology Evoked Potentials (NEPs) (L34975)
Outpatient Wireless Pulmonary Artery Pressure Monitoring for Heart Failure (L36419)
Strapping (L36423)
Therapy and Rehabilitation Services (PT, OT) (L35036)
Comments Received and Contractor Responses
Comments received during the comment period are still being considered for the following JH Draft LCDs. Please continue to watch our website for further updates:
Facet Joint Injections (DL34974)
Nerve Blockade for Treatment of Chronic Pain and Neuropathy (DL35033)
The following JH Draft LCD is not being finalized at this time. Please continue to watch our website for further updates:
Removal of Benign Skin Lesions (DL34938)
The following JH LCDs have been revised:
Controlled Substance Monitoring and Drugs of Abuse Testing (L35006)
Hyperbaric Oxygen (HBO) Therapy (L35021)
The following JH Local Coverage Article has been added:
Ventricular Assist Device (VAD) Supply or Accessory (A54910)
The following JH ICD-10 Local Coverage Determinations have been revised:
Allergen Immunotherapy (L36240)
Allergy Testing (L36241)
Assays for Vitamins and Metabolic Function (L34914)
Biomarkers for Oncology (L35396)
Cardiac Rhythm Device Evaluation (L34833)
Glaucoma Treatment with Aqueous Drainage Device (L35087)
Intraoperative Neurophysiological Testing (L35003)
Lower Extremity Major Joint Replacement (Hip and Knee) (L36007)
Medicine: Neurophysiology Evoked Potentials (NEPS) (L34975)
Outpatient Sleep Studies (L35050)
Scanning Computerized Ophthalmic Diagnostic Imaging (L35038)
Vestibular and Audiologic Function Studies (L35007)
The following JH ICD-10 Local Coverage Articles have been revised:
Biomarkers for Oncology (A52986)
NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Oncologic Conditions (A53132)
The following JH Local Coverage Determinations (LCDs) have been revised to reflect the Annual CPT/HCPCS Code updates effective for dates of service on and after January 1, 2016:
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (L35041)
Biomarkers for Oncology (L35396)
Biomarkers Overview (L35062)
Hemophilia Factor Products (L35111)
Hyaluronan Acid Therapies for Osteoarthritis of the Knee (L35427)
Implantable Infusion Pump (L35112)
Pain Management (L35033)
Spinal Cord Stimulation (Dorsal Column Stimulation) (L35450)
Thrombolytic Agents (L35428)
Transoral Incisionless Fundoplication (L34999)
Trigger Point Injections (L35010)
Vestibular and Audiologic Function Studies (L35007)
The following JH LCDs have been revised to reflect the Annual CPT/HCPCS Code updates effective for dates of service on and after January 1, 2016 and have also been revised due to a reconsideration request:
Independent Diagnostic Testing Facility (IDTF) (L35448)
Services That Are Not Reasonable and Necessary (L35094)
The following JH Local Coverage Articles have been revised to reflect the Annual CPT/HCPCS code updates effective for dates of service on and after January 1, 2016:
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (A54117)
Approved Drugs and Biologicals; Includes Cancer Chemotherapeutic Agents (A53049) (Please Note: due to the retired A53048 and to consolidate the Article across MAC jurisdictions a new number has been assigned).
Biomarkers for Oncology (A52986)
Compounded Drugs Used in an Implantable Infusion Pump (A54100)
The following JH Local Coverage Article has been revised to reflect the Annual CPT/HCPCS Code updates effective for dates of service on and after January 1, 2016 and has also been revised due to a reconsideration request:
Independent Diagnostic Testing Facility (IDTF) (A53252)
The following JH Local Coverage Article has been revised to reflect the Annual CPT/HCPCS code update and posted for notice. It will become effective date of March 17, 2016:
Self-Administered Drug Exclusion List (A53127)
The following JH Local Coverage Article has been retired effective January 1, 2016:
Approved Drugs and Biologicals; Includes Cancer Chemotherapeutic Agents (A53048)
The following JH Draft Local Coverage Determinations (LCDs) are posted for comment. The comment period ends on March 10, 2016.
Assays for Vitamins and Metabolic Function (DL34914)
Diagnostic Abdominal Aortography and Renal Angiography (DL35092)
Lumbar Epidural Injections for Pain Management (DL34892)
Non-Vascular Extremity Ultrasound (DL35409)
Pulmonary Function Testing (DL35360)
Thrombolytic Agents (DL35428)
Submit comments
The following JH Local Coverage Determinations (LCDs) which were posted for notice on November 5, 2015 are now effective:
Cardiovascular Nuclear Medicine (L35083)
Loss of Heterozygosity Based Topographic Genotyping with PathfinderTG® (L34864)
Psychiatric Codes (L35101)
The following JH Local Coverage Determinations (LCDs) which were posted for notice on November 5, 2015 have been revised and are now effective:
Controlled Substance Monitoring and Drugs of Abuse Testing (L35006)
Cosmetic and Reconstructive Surgery (L35090)
Hyperbaric Oxygen (HBO) Therapy (L35021)
Mohs Micrographic Surgery (MMS) (L34961)
Transesophageal Echocardiography (TEE) (L35016)
The following JH LCD has been placed on hold and will not become effective December 31, 2015. This LCD will become effective at a later date. Please continue to watch our website for updates:
In Vitro Chemosensitivity & Chemoresistance Assays (L36055)
The release of the Local Coverage Determinations (LCDs) and Articles revised based on the 2016 annual coding update has been delayed. The revised LCDs and Articles will be available on January 28, 2016 on the Medicare Coverage Database and the Novitas web site within the Medical Policy Center under the Active LCDs (Local Coverage Determinations) and Active Local coverage Billing & Coding Articles links. We apologize for any inconvenience.
JH - LCDs affected by the 2016 Annual HCPCS/CPT Update
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (L35041)
Biomarkers for Oncology (L35396)
Biomarkers Overview (L35062)
Hemophilia Factor Products (L35111)
Hyaluronan Acid Therapies for Osteoarthritis of the Knee (L35427)
Independent Diagnostic Testing Facility (IDTF) (L35448)
Pain Management (L35033)
Services That Are Not Reasonable and Necessary (L35094)
Spinal Cord Stimulation (Dorsal Column Stimulation) (L35450)
Thrombolytic Agents (L35428)
Transoral Incisionless Fundoplication (L34999)
Trigger Point Injections (L35010)
Vestibular and Audiologic Function Studies (L35007)
JH - Local Coverage Articles Affected by the 2016 Annual HCPCS/CPT Update
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (A54117)
Approved Drugs and Biologicals; Includes Cancer Chemotherapeutic Agents (A53048)
Biomarkers for Oncology (A52986)
Independent Diagnostic Testing Facility (IDTF) (A53252)
Self-Administered Drug Exclusion List (A53127)
The following JH ICD-10 Local Coverage Determinations have been revised:
Independent Diagnostic Testing Facility (IDTF) (L35448)
Neuromuscular Junction Testing (L34996)
Services That Are Not Reasonable and Necessary (L35094)
Surgical Treatment of Nails (L34887)
Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic) (L35350)
Wireless Capsule Endoscopy (L35089)
The following JH ICD-10 Local Coverage Article has been revised:
Independent Diagnostic Testing Facility (IDTF) (A53252)
The following JH ICD-10 Local Coverage Determinations have been revised:
Biomarkers for Oncology (L35396)
Cosmetic and Reconstructive Surgery (L35090)
Implantable Infusion Pump (L35112)
Magnetic Resonance Angiography (MRA) (L34865)
Non-Vascular Extremity Ultrasound (L35409)
Pulmonary Function Testing (L35360)
Services That Are Not Reasonable and Necessary (L35094)
Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography (L35035)
Thrombolytic Agents (L35428)
Transesophageal Echocardiography (TEE) (L35016)
Vertebroplasty, Vertebral Augmentation (Kyphoplasty) Percutaneous (L35130)
The following JH ICD-10 Local Coverage Determination has been retired:
Partial Hospitalization Programs (PHPs)-Psychiatric (L35100)
The following JH ICD-10 Local Coverage Article has been revised:
Compounded Drugs Used in an Implantable Infusion Pump (A54100)
Autonomic Function Tests (DL35395)
C-Reactive Protein High Sensitivity Testing (hsCRP) (DL34856)
Facet Joint Injections (DL34974)
Frequency of Laboratory Tests (DL35099)
Microvascular Therapy (DL36434)
Nerve Blockade for Treatment of Chronic Pain and Neuropathy (DL35033)
Neurophysiology Evoked Potentials (NEPs) (DL34975)
Outpatient Wireless Pulmonary Artery Pressure Monitoring for Heart Failure (DL36419)
Removal of Benign Skin Lesions (DL34938)
Strapping (DL36423)
Therapy and Rehabilitation Services (PT, OT) (DL35036)
The following JH Draft LCDs posted for comment on May 14, 2015 and presented at the June 2015 Contractor Advisory Committee (CAC) Meeting have been posted for notice. They will become effective December 31, 2015:
Cardiovascular Nuclear Medicine (L35083)
Controlled Substance Monitoring and Drugs of Abuse Testing (L35006)
Cosmetic and Reconstructive Surgery (L35090)
Hyperbaric Oxygen (HBO) Therapy (L35021)
In Vitro Chemosensitivity & Chemoresistance Assays (L36055)
Loss of Heterozygosity Based Topographic Genotyping with PathfinderTG® (L34864)
Mohs Micrographic Surgery (MMS) (L34961)
Psychiatric Codes (L35101)
Transesophageal Echocardiography (TEE) (L35016)
Comments Received and Contractor Responses
The comment period will close on November 5, 2015 for the following JH Draft Local Coverage Determinations (LCDs):
Autonomic Function Tests (DL35395)
C-Reactive Protein High Sensitivity Testing (hsCRP) (DL34856)
Facet Joint Injections (DL34974)
Frequency of Laboratory Tests (DL35099)
Microvascular Therapy (DL36434)
Nerve Blockade for Treatment of Chronic Pain and Neuropathy (DL35033)
Neurophysiology Evoked Potentials (NEPs) (DL34975)
Outpatient Wireless Pulmonary Artery Pressure Monitoring for Heart Failure (DL36419)
Removal of Benign Skin Lesions (DL34938)
Strapping (DL36423)
Therapy and Rehabilitation Services (PT, OT) (DL35036)
The following JH ICD-10 Local Coverage Determinations have been revised:
Assays for Vitamins and Metabolic Function (L34914)
Cardiac Rhythm Device Evaluation (L34833)
Cardiovascular Nuclear Medicine (L35083)
Diagnostic Abdominal Aortography and Renal Angiography (L35092)
Lower Extremity Major Joint Replacement (Hip and Knee) (L36007)
Monitored Anesthesia Care (L35049)
Non-Vascular Extremity Ultrasound (L35409)
Qualitative Drug Testing (L35006)
Scanning Computerized Ophthalmic Diagnostic Imaging (L35038)
Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography (L35035)
The following JH ICD-10 Local Coverage Determinations have been revised:
Non-Coronary Vascular Stents (L35084)
Treatment of Varicose Veins and Venous Stasis Disease of the Lower Extremities (L34924)
Wound Care (L35125)
The following JH LCDs have been retired effective October 1, 2015
Transthoracic Echocardiography (TTE) (L35017)
Interventional Cardiology (L35066)
The following JH ICD-10 Local Coverage Determinations (LCDs) have been revised:
Assays for Vitamins and Metabolic Function (L34914)
Biomarkers for Oncology (L35396)
Hyperbaric Oxygen (HBO) Therapy (L35021)
Psychiatric Codes (L35101)
Scanning Computerized Ophthalmic Diagnostic Imaging (L35038)
Services That Are Not Reasonable and Necessary (L35094)
Therapy Services (PT, OT, SLP) (L35036)
Upper Gastrointestinal Endoscopy (Diagnostic And Therapeutic) (L35350)
Wound Care (L35125)
The following JH ICD-10 Local Coverage Article has been revised:
Biomarkers for Oncology (A52986)
The following JH Draft Local Coverage Determinations (LCDs) are posted for comment. The comment period ends on November 5, 2015. Please note that the Draft LCDs will not become effective until after ICD-10 is implemented. Therefore, all Draft LCDs are in ICD-10 format.
Autonomic Function Tests (DL35395)
C-Reactive Protein High Sensitivity Testing (hsCRP) (DL34856)
Facet Joint Injections (DL34974)
Frequency of Laboratory Tests (DL35099)
Microvascular Therapy (DL36434)
Nerve Blockade for Treatment of Chronic Pain and Neuropathy (DL35033)
Neurophysiology Evoked Potentials (NEPs) (DL34975)
Outpatient Wireless Pulmonary Artery Pressure Monitoring for Heart Failure (DL36419)
Removal of Benign Skin Lesions (DL34938)
Strapping (DL36423)
Therapy and Rehabilitation Services (PT, OT) (DL35036)
Submit Comments
The following JH Local Coverage Determinations (LCDs) have been revised:
Biomarkers Overview (L33638)
Intraoperative Neurophysiological Testing (L32605)
Outpatient Sleep Studies (L32711)
Services That Are Not Reasonable and Necessary (L31686)
Treatment of Varicose Veins and Venous Stasis Disease of the Lower Extremities (L32678)
The following JH Local Coverage Article has been revised:
Approved Drugs and Biologicals Includes Cancer Chemotherapeutic Agents (A52018)
The following JH Local Coverage Determinations (LCDs) which were posted for notice on June 25, 2015 are now effective:
Allergy Testing (L35771)
Biomarkers Overview (L33638)
Debridement of Mycotic Nails (L27487)
Magnetic Resonance Angiography (MRA) (L31399)
Surgical Treatment of Nails (L27532)
Vestibular and Audiologic Function Studies (L32767)
The following JH Local Coverage Determination (LCD) which was posted for notice on June 25, 2015 has been revised and is now effective:
Allergen Immunotherapy (L35759)
The following JH Local Coverage Determinations (LCDs) have been revised:
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (L27549)
Biomarkers for Oncology (L34796)
Hemophilia Factor Products (L33658)
Nerve Conduction Studies and Electromyography (L32723)
Services That Are Not Reasonable and Necessary (L31686)
The following JH LCDs have been retired effective August 12, 2015:
Magnetic Resonance Angiography (MRA) (L32611)
Mycotic Nail Debridement (L32634)
Nail Avulsion (L32637)
The following JH LCD has been posted for notice and will be effective October 1, 2015:
Ambulance Services (Ground Ambulance) (L35162)
Additional information/Comments Received and Contractor Responses
The following JH Local Coverage Article is now effective:
Surgical Treatment of Nails (A47803)
The following JH Articles have been revised:
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (A54115)
Compounded Drugs Used in an Implantable Infusion Pump (A54099)
Independent Diagnostic Testing Facility (IDTF) (A53186)
The following JH Article has been revised and posted for notice. It will become effective October 1, 2015.
Self-Administered Drug Exclusion List (A53127)
The following JH Article has been added and will be effective October 1, 2015:
Ambulance Services (Ground Ambulance) (A54574)
The following JH Local Coverage Article has been added. It will become effective August 13, 2015:
Surgical Treatment of Nails (A47803)
The comment period is now closed for the following JH Draft Local Coverage Determinations (LCDs):
Cardiovascular Nuclear Medicine (DL35083)
Controlled Substance Monitoring and Drugs of Abuse Testing (DL35006)
Cosmetic and Reconstructive Surgery (DL35090)
Hyperbaric Oxygen (HBO) Therapy (DL35021)
In Vitro Chemosensitivity & Chemoresistance Assays (DL36055)
Loss of Heterozygosity Based Topographic Genotyping with PathfinderTG® (DL34864)
Mohs Micrographic Surgery (DL34961)
Psychiatric Codes (DL35101)
Transesophageal Echocardiography (TEE) (DL35016)
The following JH Local Coverage Determinations (LCDs) have been revised:
Implantable Infusion Pump (L33115)
Nerve Conduction Studies and Electromyography (L32723)
The following JH Local Coverage Articles have been revised:
Compounded Drugs Used in an Implantable Infusion Pump (A54099)
Nerve Conduction Studies and Electromyography (A54094)
The following JH Local Coverage Articles have been added:
Acute Care: Inpatient, Observation and Treatment Room Services (A47796)
Prepackaged Kits (A54514)
The comment period will close on July 9, 2015 for the following JH Draft Local Coverage Determinations (LCDs):
Please note that the Draft LCDs will not become effective until after ICD-10 is implemented. Therefore, all Draft LCDs are in ICD-10 format.
Cardiovascular Nuclear Medicine (DL35083)
Controlled Substance Monitoring and Drugs of Abuse Testing (DL35006)
Cosmetic and Reconstructive Surgery (DL35090)
Hyperbaric Oxygen (HBO) Therapy (DL35021)
In Vitro Chemosensitivity & Chemoresistance Assays (DL36055)
Loss of Heterozygosity Based Topographic Genotyping with PathfinderTG® (DL34864)
Mohs Micrographic Surgery (DL34961)
Psychiatric Codes (DL35101)
Transesophageal Echocardiography (TEE) (DL35016)
Due to system limitations, between June 25, 2015 and August 12, 2015, the following JH Local Coverage Determinations (LCDs) accessed through the policy search application are future LCDs that will become effective on August 13, 2015: L32767 and L33638. During this time period, the active (current) versions of these LCDs can be accessed below or on the Full Index of Current Active LCDs and Future Effective LCDs.
Biomarkers Overview (L33638)
Vestibular and Audiologic Function Studies (L32767)
The following JH Draft LCDs posted for comment on January 15, 2015 and presented at the February 2015 Contractor Advisory Committee (CAC) Meeting have been posted for notice. They will become effective August 13, 2015:
Allergen Immunotherapy (L35759)
Allergy Testing (L35771)
Debridement of Mycotic Nails (L27487)
Magnetic Resonance Angiography (MRA) (L31399)
Surgical Treatment of Nails (L27532)
Vestibular and Audiologic Function Studies (L32767)
The following JH Draft LCD posted for comment on January 26, 2015 and presented at the February 2015 CAC Meeting has been posted for notice. It will become effective August 13, 2015.
Biomarkers Overview (L33638)
Comments Received and Contractor Responses
The following JH Draft LCDs will not be finalized at this time. Please continue to watch our website for further updates.
Ambulance Services (Ground Ambulance) (DL32606)
Autonomic Function Tests (DL34788)
Tear Testing for Dry Eyes (DL35823)
The following JH LCDs have been revised:
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (L27549)
Interventional Cardiology (L32603)
Monitored Anesthesia Care (L32628)
Services That Are Not Reasonable and Necessary (L31686)
The JH Implantable Infusion Pump LCD (L32740) has been assigned a new L number. Please refer to L33115 for dates of service on or after June 25, 2015.
Implantable Infusion Pump (L33115)
The following JH Local Coverage Article has been added:
Microvascular Therapy (MVT) (A54342)
The following JH Local Coverage Bulletin has been revised:
Coverage of Gender Reassignment Surgery – Provider Bulletin (A53853)
The following JH Draft Local Coverage Determinations (LCDs) are posted for comment. The comment period ends on July 9, 2015. Please note that the Draft LCDs will not become effective until after ICD-10 is implemented. Therefore, all Draft LCDs are in ICD-10 format.
Cardiovascular Nuclear Medicine (DL35083)
Controlled Substance Monitoring and Drugs of Abuse Testing (DL35006)
Cosmetic and Reconstructive Surgery (DL35090)
Hyperbaric Oxygen (HBO) Therapy (DL35021)
In Vitro Chemosensitivity & Chemoresistance Assays (DL36055)
Loss of Heterozygosity Based Topographic Genotyping with PathfinderTG® (DL34864)
Mohs Micrographic Surgery (DL34961)
Psychiatric Codes (DL35101)
Transesophageal Echocardiography (TEE) (DL35016)
The following JH Local Coverage Determinations (LCDs) have been revised:
Hemophilia Factor Products (L33658)
Hyperbaric Oxygen (HBO) Therapy (L32739)
Treatment of Varicose Veins and Venous Stasis Disease of the Lower Extremities (L32678)
The following JH Local Coverage Provider Bulletin has been retired effective May 6, 2015. For dates of service on and after May 7, 2015, please reference Article A54099, Compounded Drugs Used in an Implantable Infusion Pump.
Part B Compounded Drugs Used in an Implantable Infusion Pump-Provider Bulletin (A52751)
The following JH Local Coverage Article has been revised and is now effective:
Compounded Drugs Used in an Implantable Infusion Pump (A54099)
The technical issues have been resolved for the following revised JH Local Coverage Determination (LCD). The current version of this LCD is now accessible through our Search function and the link below:
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (L27549)
The following JH Local Coverage Determination (LCD) has been revised; however, due to technical issues it is temporarily not available through our Search function. Please reference the below link until the issue is resolved:
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (L27549)
The following JH Local Coverage Article has been revised and will become effective May 7, 2015.
Compounded Drugs Used in an Implantable Infusion Pump (A54099)
The following JH Local Coverage Determination (LCDs) which were posted for notice on February 20, 2015 are now effective:
Blood Glucose Monitoring in a Skilled Nursing Facility (SNF) (L27475)
Coverage of Services and Procedures in Nursing Facilities (L27485)
Diagnostic Abdominal Aortography and Renal Angiography (L32709)
Evaluation and Management Services Provided in a Nursing Facility (L27496)
Hemophilia Factor Products (L33658)
Hydration Therapy (L32738)
Lower Extremity Major Joint Replacement (Hip and Knee) (L35594)
Monitored Anesthesia Care (MAC) (L32628)
Non-Coronary Vascular Stents (L32641)
Speech-Language Pathology (SLP) Services: Dysphagia; Includes VitalStim® Therapy (L27537)
Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography (L32673)
The following JH MAC Local Coverage Determination (LCDs) which were posted for notice on February 20, 2015 are now effective. These LCDs have also been revised:
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (L27549)
Co-Management of Surgical Procedures (L27481)
Speech-Language Pathology (SLP) Services: Communication Disorders (L27531)
The following JH LCDs have been retired effective April 8, 2015 for dates of service on and after April 9, 2015:
Bioengineered Skin Substitutes (L32622)
Hemophilia Factor Products (L32735)
The following JH Local Coverage Articles have been added:
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (A54115)
Speech-Language Pathology (SLP) Services: Communication Disorders (A54110)
Co-Management of Surgical Procedures (A47790)
The comment period for the following JH Draft Local Coverage Determination (LCD) ends today:
Biomarkers Overview (DL33638)
The following JH Local Coverage Article has been added. It will become effective May 7, 2015.
Compounded Drugs Used in an Implantable Infusion Pump (A54099)
The following JH Local Coverage Determinations (LCDs) have been revised:
Cardiac Rhythm Device Evaluation (L30529)
Nerve Conduction Studies and Electromyography (L32723)
Services That Are Not Reasonable and Necessary (L31686)
Treatment of Varicose Veins and Venous Stasis Disease of the Lower Extremities (L32678)
The following JH Local Coverage Article has been revised:
Independent Diagnostic Testing Facility (IDTF) (A53186)
The following JH Local Coverage Article has been added:
Nerve Conduction Studies and Electromyography (A54094)
The comment period is now closed for the JH Draft Local Coverage Determinations (LCDs) listed below. The comments received are being reviewed by our Contractor Medical Directors.
Allergen Immunotherapy (DL35759)
Allergy Testing (DL35771)
Ambulance Services (Ground Ambulance) (DL32606)
Autonomic Function Tests (DL34788)
Debridement of Mycotic Nails (DL27487)
Magnetic Resonance Angiography (MRA) (DL31399)
Surgical Treatment of Nails (DL27532)
Tear Testing for Dry Eyes (DL35823)
Vestibular and Audiologic Function Studies (DL32767)
Novitas will accept comments for the following draft until March 19, 2015:
Biomarkers Overview (DL33638)
The comment period will close on March 5, 2015 for the following JH Draft Local Coverage Determinations (LCDs):
Allergen Immunotherapy (DL35759)
Allergy Testing (DL35771)
Ambulance Services (Ground Ambulance) (DL32606)
Autonomic Function Tests (DL34788)
Debridement of Mycotic Nails (DL27487)
Magnetic Resonance Angiography (MRA) (DL31399)
Surgical Treatment of Nails (DL27532)
Tear Testing for Dry Eyes (DL35823)
Vestibular and Audiologic Function Studies (DL32767)
Please Note: As previously communicated Novitas will accept comments for the following draft until March 19, 2015:
Biomarkers Overview DL33638
Due to system limitations, between February 20, 2015 and April 8, 2015, the following JH Local Coverage Determinations (LCDs) accessed through the policy search application are future LCDs that will become effective on April 9, 2015. The active (current) LCDs can be accessed below or by the Full Index of Current Active LCDs and Future Effective LCDs
Diagnostic Abdominal Aortography and Renal Angiography (L32709)
Hydration Therapy (L32738)
Non-Coronary Vascular Stents (L32641)
Monitored Anesthesia Care (L32628)
Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography (L32673)
The following JH Draft LCDs posted for comment on September 18, 2014 and presented at the October 2014 Contractor Advisory Committee (CAC) Meeting have been posted for notice. They will become effective April 9, 2015.
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (L27549)
Blood Glucose Monitoring in a Skilled Nursing Facility (SNF) (L27475)
Co-Management of Surgical Procedures (L27481)
Coverage of Services and Procedures in Nursing Facilities (L27485)
Diagnostic Abdominal Aortography and Renal Angiography (L32709)
Evaluation and Management Services Provided in a Nursing Facility (L27496)
Hemophilia Factor Products (L33658)
Hydration Therapy (L32738)
Lower Extremity Major Joint Replacement (Hip and Knee) (L35594)
Non-Coronary Vascular Stents (L32641)
Speech-Language Pathology (SLP) Services: Communication Disorders (L27531)
Speech-Language Pathology (SLP) Services: Dysphagia; Includes VitalStim® Therapy (L27537)
Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography (L32673)
The following JH Draft LCD posted for comment on May 15, 2014 and presented at the June 2014 CAC Meeting has been posted for notice. It will become effective April 9, 2015.
Monitored Anesthesia Care (L32628)
Comments Received and Contractor Responses
The following JH draft will not be finalized at this time. Please continue to watch our website for further updates:
Gender Reassignment Surgery (DL35573)
The following JH LCDs have been revised:
Services That Are Not Reasonable and Necessary L31686
Transthoracic Echocardiography (TTE) L32675
Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic) L34745
The following JH Article has been revised:
NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Oncologic Conditions A49325
The draft Local Coverage Determination (LCD) DL33638, Biomarkers Overview has been reposted to the Novitas Solutions Website for comments. If you are interested in presenting on the Biomarkers Overview policy at the Open Meeting on Thursday, January 29, 2015, please contact us immediately by submitting an online registration or notification through e-mail to: Karen.ryan@novitas-solutions.com.
For more details on the Open Meeting, please click here.
Note: The Draft LCD DL33638 will not be available on the Medicare Coverage Database until Thursday January 29, 2015. Due to the delay in posting, the comment period for this draft will be extended until March 19, 2015. We apologize for any inconvenience.
Biomarkers Overview DL33638
The following JH Local Coverage Determinations (LCDs) have been revised to reflect the Annual CPT/HCPCS Code updates effective for dates of service on and after January 1, 2015:
Bioengineered Skin Substitutes L32622
Cardiac Rhythm Device Evaluation L30529
Cardiovascular Nuclear Medicine L32635
Glaucoma Treatment with Aqueous Drainage Device L32733
Hemophilia Factor Products L32735
Hyaluronan Acid Therapies for Osteoarthritis of the Knee L32237
Hyperbaric Oxygen (HBO) Therapy L32739
Independent Diagnostic Testing Facility (IDTF) L34792
Non-Coronary Vascular Stents L32641
Psychiatric Codes L32766
Qualitative Drug Testing L34352
Services That Are Not Reasonable and Necessary L31686
Spinal Cord Stimulation (Dorsal Column Stimulation) L34705
Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic) L34745
Vertebroplasty, Vertebral Augmentation (Kyphoplasty) Percutaneous L32685
Wound Care L32687
The following JH LCD has been revised to reflect the Annual CPT/HCPCS Code updates effective for dates of service on and after January 1, 2015 and has also been revised due to a reconsideration request:
Biomarkers for Oncology L34796
The following JH Local Coverage Articles have been revised to reflect the Annual CPT/HCPCS code updates effective for dates of service on and after January 1, 2015:
Approved Drugs and Biologicals; Includes Cancer Chemotherapeutic Agents A52018
Biomarkers for Oncology A52317
Independent Diagnostic Testing Facility (IDTF) A53186
The following JH Local Coverage Article has been added:
Capsaicin Patch A50870
Draft LCD DL33638, Biomarkers Overview, was posted for comment in error. We are in the process of having the draft LCD removed from both the Medicare Coverage Database and from the Novitas web site. Please continue to watch our web site for further information. We apologize for the inconvenience.
The following JH Draft Local Coverage Determinations are posted for comment. The comment period ends on March 5, 2015.
Allergen Immunotherapy (DL35759)
Allergy Testing (DL35771)
Ambulance Services (Ground Ambulance) (DL32606)
Autonomic Function Tests (DL34788)
Debridement of Mycotic Nails (DL27487)
Magnetic Resonance Angiography (MRA) (DL31399)
Surgical Treatment of Nails (DL27532)
Tear Testing for Dry Eyes (DL35823)
Vestibular and Audiologic Function Studies (DL32767)
Please be advised that due to the holiday on 01/19/2015, the 2015 HCPCS/CPT Annual Updates will be available on the Novitas Website and the Medicare Coverage Database on 01/23/2015.
The release of the Local Coverage Determinations (LCDs) and Articles revised based on the 2015 annual coding update has been delayed. The revised LCDs and Articles will be available on January 22, 2015 on the Medicare Coverage Database and the Novitas web site within the Medical Policy Center under the Latest LCD Updates & Update History link. We apologize for any inconvenience.
JH - LCDs affected by the 2015 Annual HCPCS/CPT Update
L32766 Psychiatric Codes
L32687 Wound Care
L32635 Cardiovascular Nuclear Medicine
L32739 Hyperbaric Oxygen (HBO) Therapy
L32685 Vertebroplasty, Vertebral Augmentation (Kyphoplasty) Percutaneous
L32735 Hemophilia Factor Products
L32733 Glaucoma Treatment with Aqueous Drainage Device
L32622 Bioengineered Skin Substitutes
L32641 Non-Coronary Vascular Stents
L30529 Cardiac Rhythm Device Evaluation
L31686 Services That Are Not Reasonable and Necessary
L32237 Hyaluronon Acid Therapies for Osteoarthritis of the Knee
L34705 Spinal Cord Stimulation (Dorsal Column Stimulation)
L34745 Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)
L34792 Independent Diagnostic Testing Facility (IDTF)
L34796 Biomarkers for Oncology
L34352 Qualitative Drug Testing
JH - Local Coverage Articles Affected by the 2015 Annual HCPCS/CPT Update
A52018 Approved Drugs and Biologicals; Includes Cancer Chemotherapeutic Agents
A53186 Independent Diagnostic Testing Facility (IDTF)
A52317 Biomarkers for Oncology
The following JH LCDs have been revised:
Bariatric Surgical Management of Morbid Obesity (L32619)
Non-Invasive Peripheral Venous Studies (L34714)
Sacral Nerve Stimulation (L34707)
Therapy Services (PT, OT, SLP) (L32710)
The following JH Local Coverage Determinations (LCDs) which were posted for notice on October 9, 2014 are now effective:
Cardiac Event Detection Monitoring (L32679)
Cardiac Rhythm Device Evaluation (L30529)
Intravenous Immune Globulin (IVIG) (L32712)
Luteinizing Hormone-Releasing Hormone (LHRH) Analogs (L32610)
Pharmacokinetic (PK) Testing for Chemotherapy Dosing (L35269)
Routine Foot Care (L27486)
Services That Are Not Reasonable and Necessary (L31686)
Transoral Incisionless Fundoplication (L32932)
Treatment of Varicose Veins and Venous Stasis Disease of the Lower Extremities (L32678)
The following JH Local Coverage Article has been added:
Routine Foot Care (A51184)
The following JH LCDs have been retired effective December 3, 2014:
Category III Codes (L32691)
Extracorporeal Shock Wave Therapy (ESWT) (L32729)
Lumbar Matrix Scan (L32609)
Off Label Use Autologous Cellular Immunotherapy Treatment of Malignancy of Prostate (L32615)
Routine Foot Care (L32669)
Transoral Incisionless Fundoplication (L32620)
The following JH Local Coverage Article has been added:
Mohs Micrographic Surgery (MMS) (A53852)
The following JH LCDs have been revised:
Independent Diagnostic Testing Facility (IDTF) (L34792)
Mohs Micrographic Surgery (MMS) (L32627)
Transthoracic Echocardiography (TTE) (L32675)
The following JH Local Coverage Article has been revised:
Independent Diagnostic Testing Facility (IDTF) (A53186)
The comment period is now closed for the JH Draft Local Coverage Determination (LCD) listed below. The comments received are now being reviewed by our Contractor Medical Directors.
Evaluation and Management Services Provided in a Nursing Facility (DL27496)
The comment period is now closed for the JH Draft Local Coverage Determinations (LCDs) listed below. The comments received are being reviewed by our Contractor Medical Directors.
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (DL27549)
Blood Glucose Monitoring in a Skilled Nursing Facility (SNF) (DL27475)
Co-Management of Surgical Procedures (DL27481)
Coverage of Services and Procedures in Nursing Facilities (DL27485)
Diagnostic Abdominal Aortography and Renal Angiography (DL32709)
Gender Reassignment Surgery (DL35573)
Hemophilia Factor Products (DL33658)
Hydration Therapy (DL32738)
Lower Extremity Major Joint Replacement (Hip and Knee) (DL35594)
Non-Coronary Vascular Stents (DL32641)
Speech - Language Pathology (SLP) Services: Communication Disorders (DL27531)
Speech-Language Pathology (SLP) Services: Dysphagia; Includes VitalStim ® Therapy (DL27537)
Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography (DL32673)
The comment period will close on November 6, 2014 for the following JH Draft Coverage Determinations (LCDs):
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (DL27549)
Blood Glucose Monitoring in a Skilled Nursing Facility (SNF) (DL27475)
Co-Management of Surgical Procedures (DL27481)
Coverage of Services and Procedures in Nursing Facilities (DL27485)
Diagnostic Abdominal Aortography and Renal Angiography (DL32709)
Gender Reassignment Surgery (DL35573)
Hemophilia Factor Products (DL33658)
Hydration Therapy (DL32738)
Lower Extremity Major Joint Replacement (Hip and Knee) (DL35594)
Non-Coronary Vascular Stents (DL32641)
Speech - Language Pathology (SLP) Services: Communication Disorders (DL27531)
Speech-Language Pathology (SLP) Services: Dysphagia; Includes VitalStim ® Therapy (DL27537)
Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography (DL32673)
Please Note: As previously communicated Novitas will accept comments for the following draft until November 13, 2014:
Evaluation and Management Services Provided in a Nursing Facility (DL27496)
Due to system limitations, between October 9, 2014 and December 3, 2014 the following JH LCDs accessed through the policy search application are future LCDs that will become effective on December 4, 2014. The active (current) LCDs can be accessed below or by the following link. Full Index of Current Active LCDs and Future Effective LCDs
Cardiac Event Detection Monitoring (L32679)
Intravenous Immune Globulin (IVIG) (L32712)
Luteinizing Hormone-Releasing Hormone (LHRH) Analogs (L32610)
Treatment of Varicose Veins in Lower Extremities (L32678)
The following JH Local Coverage Determinations have been posted for notice. They will become effective December 4, 2014:
Cardiac Event Detection Monitoring (L32679)
Cardiac Rhythm Device Evaluation (L30529)
Intravenous Immune Globulin (IVIG) (L32712)
Luteinizing Hormone-Releasing Hormone (LHRH) Analogs (L32610)
Pharmacokinetic (PK) Testing for Chemotherapy Dosing (L35269)
Routine Foot Care (L27486)
Services That Are Not Reasonable and Necessary (L31686)
Transoral Incisionless Fundoplication (L32932)
Treatment of Varicose Veins and Venous Stasis Disease of the Lower Extremities (L32678)
Comments Received and Contractor Responses
The following JH drafts are not being finalized at this time. The current active LCDs will remain in effect:
Debridement of Mycotic Nails (DL27487)
Monitored Anesthesia Care (DL32628)
Surgical Treatment of Nails (DL27532)
The following JH LCDs have been revised:
Biomarkers for Oncology (L34796)
Category III Codes (L32691)
Sacral Nerve Stimulation (L34707)
Spinal Cord Stimulation (Dorsal Column Stimulation) (L34705)
Thrombolytic Agents (L34743)
The following JH LCD has been retired:
MyPRS Genetic Expression Profile Testing (L32636)
The following JH Articles have been revised:
Biomarkers for Oncology (A52317)
NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Oncologic Conditions (A49325)
Due to technical issues, the following LCDs which are currently in effect are not displaying on Novitas Solutions website or the Medicare Coverage Database. This issue is being corrected with an anticipated resolution date of October 2, 2014.
Luteinizing Hormone-Releasing Hormone (LHRH) Analogs (L32610)
Treatment of Varicose Veins in Lower Extremities (L32678)
The following JH Local Coverage Determination (LCD) has been retired effective September 17, 2014:
Circulating Tumor Cell (CTC) Assay (L33232)
The following JH Draft Local Coverage Determinations are posted for comment. The comment period ends on November 6, 2014:
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (DL27549)
Blood Glucose Monitoring in a Skilled Nursing Facility (SNF) (DL27475)
Co-Management of Surgical Procedures (DL27481)
Coverage of Services and Procedures in Nursing Facilities (DL27485)
Diagnostic Abdominal Aortography and Renal Angiography (DL32709)
Gender Reassignment Surgery (DL35573)
Hemophilia Factor Products (DL33658)
Hydration Therapy (DL32738)
Lower Extremity Major Joint Replacement (Hip and Knee) (DL35594)
Non-Coronary Vascular Stents (DL32641)
Speech - Language Pathology (SLP) Services: Communication Disorders (DL27531)
Speech-Language Pathology (SLP) Services: Dysphagia; Includes VitalStim ® Therapy (DL27537)
Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography (DL32673)
Please Note: Draft LCD DL27496 (see link below) is currently not displaying on the Medicare Coverage Database (MCD). The draft is available for review and comment on the Novitas Website and will display on the MCD September 25. Due to the delay in the draft displaying on the MCD, Novitas will accept comments for this draft until November 13, 2014.
Evaluation and Management Services Provided in a Nursing Facility (DL27496)
Submit Comments
The following JH LCDs have been revised:
Anorectal Manometry, Anal Electromyography, and Biofeedback Training for Perineal Muscles and Anorectal or Urethral Sphincters (L33140)
Cataract Extraction (including Complex Cataract Surgery) (L32690)
Mycotic Nail Debridement (L32634)
Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic) (L34745)
The following JH LCDs have been revised:
Biomarkers for Oncology (L34796)
Biomarkers Overview (L33638)
Thrombolytic Agents (L34743)
Vestibular and Audiologic Function Studies (L32767)
The following JH Article has been added effective August 14, 2014:
Isolated Ultrafiltration for Management of Fluid Overload
in Cardiac Disease (A51037)
The following JH Local Coverage Article was retired and replaced with Local Coverage Article NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions (A47551) to create a uniform Local Coverage Article across MAC Jurisdictions.
NCD Coding Article for Positron Emission Tomography
(PET) Scans Used for Non-Oncologic Conditions (A52202)
The following JH Local Coverage Article was retired and replaced with Local Coverage Article NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Oncologic Conditions (A49325) to create a uniform Local Coverage Article across MAC Jurisdictions.
NCD Coding Article for Positron Emission Tomography
(PET) Scans Used for Oncologic Conditions (A52203)
The following JH Local Coverage Article was retired and replaced with Local Coverage Real-Time, Outpatient Cardiac Telemetry (A51214) to create a uniform Local Coverage Article across MAC Jurisdictions.
Real-Time, Outpatient Cardiac Telemetry (A52298)
The following JH Local Coverage Determinations (LCDs) which were posted for notice on June 5, 2014 are now effective:
3D Interpretation and Reporting of Imaging Studies (L34709)
Autonomic Function Tests (L34788)
Barium Swallow Studies, Modified (L34747)
Biomarkers for Oncology (L34796)
Chiropractic Services (L34816)
Hyaluronan Acid Therapies for Osteoarthritis of the Knee (L32237)
Independent Diagnostic Testing Facility (IDTF) (L34792)
Magnetic Pelvic Floor Stimulation (MPFS) (L34612)
Multiple Imaging in Oncology (L34790) (also revised)
Non-Invasive Cerebrovascular Arterial Studies (L34711) (also revised)
Non-Invasive Peripheral Venous Studies (L34714)
Non-Vascular Extremity Ultrasound (L34716) (also revised)
Oximetry Services (L34749)
Pulmonary Function Testing (L34751)
Sacral Nerve Stimulation (L34707)
Spinal Cord Stimulation (Dorsal Column Stimulation) (L34705)
Thrombolytic Agents (L34743)
Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic) (L34745)
The following JH LCD has been revised:
Biomarkers Overview (L33638)
The following JH LCDs have been retired effective July 23, 2014:
3D Interpretation and Reporting of Imaging Studies (L32602)
Barium Swallow Studies, Modified (L32621)
Biomarkers for Oncology (L33138)
Chiropractic Services (L32718)
Hyaluronate Polymers (L32737)
Oximetry Services (L32700)
Pulmonary Function Testing (L32762)
Sacral Nerve Stimulation (L32749)
Spinal Cord Stimulation (Dorsal Column Stimulation) (L32753)
Thrombolytic Agents (L32756)
Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic) (L32681)
The following JH Local Coverage Article which was posted for notice on June 5, 2014 is now effective:
Independent Diagnostic Testing Facility (IDTF) (A53186) (also revised)
The following JH Local Coverage Articles have been added:
Chiropractic Services (A47798)
Non Invasive Cerebrovascular Arterial Studies (A47800)
Non Invasive Peripheral Venous Studies (A47801)
The following JH Local Coverage Article has been revised:
Biomarkers for Oncology (A52317)
The comment period is now closed for the following JH MAC Draft Local Coverage Determinations (LCDs). The comments received are being reviewed by our Contractor Medical Directors.
DL32679 Cardiac Event Detection Monitoring
DL30529 Cardiac Rhythm Device Evaluation
DL27487 Debridement of Mycotic Nails
DL32712 Intravenous Immune Globulin (IVIG)
DL32610 Luteinizing Hormone-Releasing Hormone (LHRH) Analogs
DL32628 Monitored Anesthesia Care
DL35269 Pharmacokinetic (PK) Testing for Chemotherapy Dosing
DL27486 Routine Foot Care
DL31686 Services That Are Not Reasonable and Necessary
DL27532 Surgical Treatment of Nails
DL32932 Transoral Incisionless Fundoplication
DL32678 Treatment of Varicose Veins and Venous Stasis Disease of the Lower Extremities
The following JH Local Coverage Determinations (LCDs) have been revised:
Ambulance Services (Ground Ambulance) (L32606)
Bioengineered Skin Substitutes (L32622)
Category III Codes (L32691)
Hemophilia Factor Products (L32735)
Hyperbaric Oxygen (HBO) Therapy (L32739)
The comment period will close on July 10, 2014 for the following JH Draft Local Coverage Determinations (LCDs):
DL32679 Cardiac Event Detection Monitoring
DL30529 Cardiac Rhythm Device Evaluation
DL27487 Debridement of Mycotic Nails
DL32712 Intravenous Immune Globulin (IVIG)
DL32610 Luteinizing Hormone-Releasing Hormone (LHRH) Analogs
DL32628 Monitored Anesthesia Care
DL35269 Pharmacokinetic (PK) Testing for Chemotherapy Dosing
DL27486 Routine Foot Care
DL31686 Services That Are Not Reasonable and Necessary
DL27532 Surgical Treatment of Nails
DL32932 Transoral Incisionless Fundoplication
DL32678 Treatment of Varicose Veins and Venous Stasis Disease of the Lower Extremities
Submit Comments
Initial Treatment Date on Chiropractic Claims
Novitas would like to remind providers that according to the Medicare Claims Processing Manual, Publication 100-04, Chapter 12, Section 220 all chiropractic claims must contain the date of initial treatment or date of exacerbation of the existing condition. Consistent with Medicare guidelines, Novitas will require that all chiropractic claims contain the initial treatment date or the date of exacerbation of the existing condition effective for dates of service July 24, 2014 and after.
The JH MAC draft LCD L34794 Hyperbaric Oxygen (HBO) Therapy scheduled to become effective on 07/24/2014 has been placed on hold. Therefore, the current JH LCD L32739 will remain effective.
The following JH Local Coverage Determinations (LCDs) have been revised:
Biomarkers Overview (L33638)
Circulating Tumor Cell (CTC) Assay (L33232)
The following JH Local Coverage Determinations (LCDs) have been revised:
Biomarkers Overview (L33638)
Cataract Extraction (including Complex Cataract Surgery) (L32690)
Nerve Conduction Studies and Electromyography (L32723)
Oral Maxillofacial Prosthesis (L32643)
Qualitative Drug Testing (L34352)
Vertebroplasty, Vertebral Augmentation (Kyphoplasty) Percutaneous (L32685)
The following JH Local Coverage Articles have been revised:
Approved Drugs and Biologicals; Includes Cancer Chemotherapeutic Agents (A52018)
NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions (A52202)
The following JH Local Coverage Determinations have been posted for notice. They will become effective July 24, 2014:
Autonomic Function Tests (L34788)
Biomarkers for Oncology (L34796)
Chiropractic Services (L34816)
Hyperbaric Oxygen (HBO) Therapy (L34794)
Independent Diagnostic Testing Facility (IDTF) (L34792)
Magnetic Pelvic Floor Stimulation (MPFS) (L34612)
Multiple Imaging in Oncology (L34790)
Non-Invasive Cerebrovascular Arterial Studies (L34711)
Non-Invasive Peripheral Venous Studies (L34714)
Non-Vascular Extremity Ultrasound (L34716)
Comments Received and Contractor Responses
The following JH LCDs have been revised to create uniform LCDs with the corresponding Novitas Solutions JL LCDs. The following LCDs will also become effective July 24, 2014:
3D Interpretation and Reporting of Imaging Studies (L34709)
Barium Swallow Studies, Modified (L34747)
Hyaluronan Acid Therapies for Osteoarthritis of the Knee (L32237)
Oximetry Services (L34749)
Pulmonary Function Testing (L34751)
Sacral Nerve Stimulation (L34707)
Spinal Cord Stimulation (Dorsal Column Stimulation) (L34705)
Thrombolytic Agents (L34743)
Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic) (L34745)
Through the creation of uniform LCDs across Novitas MAC jurisdictions several of the revised LCDs have been assigned new LCD numbers. The current associated LCDs will be retired when the new LCDs become effective.
The following JH Local Coverage Article has been posted for notice. It will become effective July 24, 2014:
Independent Diagnostic Testing Facility (IDTF) (A53186)
The following JH MAC Draft Local Coverage Determinations are posted for comment. The comment period ends on July 10, 2014:
DL32679 Cardiac Event Detection Monitoring
DL30529 Cardiac Rhythm Device Evaluation
DL27487 Debridement of Mycotic Nails
DL32712 Intravenous Immune Globulin (IVIG)
DL32610 Luteinizing Hormone-Releasing Hormone (LHRH) Analogs
DL32628 Monitored Anesthesia Care
DL35269 Pharmacokinetic (PK) Testing for Chemotherapy Dosing
DL27486 Routine Foot Care
DL31686 Services That Are Not Reasonable and Necessary
DL27532 Surgical Treatment of Nails
DL32932 Transoral Incisionless Fundoplication
DL32678 Treatment of Varicose Veins and Venous Stasis Disease of the Lower Extremities
Submit Comments
The following JH MAC Local Coverage Determinations (LCDs) have been revised:
Category III Codes (L32691)
Cosmetic and Reconstructive Surgery (L32763)
Flow Cytometry (L32730)
Intravenous Immune Globulin (IVIG) (L32712)
Pulmonary Function Testing (L32762)
The following JH MAC Local Coverage Determinations (LCDs) which were posted for notice on February 6, 2014 are now effective:
Bariatric Surgical Management of Morbid Obesity (L32619)
Frequency of Dialysis (L32755)
Glaucoma Treatment with Aqueous Drainage Device (L32733)
Hemophilia Factor Products (L32735)
Infrared Photocoagulation (IRC) of Hemorrhoids (L34350)
Intraoperative Neurophysiological Testing (L32605)
Lacrimal Punctum Plugs (L32607)
Outpatient Sleep Studies (L32711)
Qualitative Drug Testing (L34352)
Surgery: Blepharoplasty (L32715)
Vascular Access for Hemodialysis (L32708)
Wireless Capsule Endoscopy (L32686)
The JH MAC draft LCD L32687 Wound Care and Cellular and/or Tissue-Based Products for Wounds scheduled to become effective on 3/27/2014 has been placed on hold. Therefore, the LCD has been reverted back to the version effective prior to the 3/27/2014 revisions and has been revised for dates of service on and after 01/01/2014 to reflect the annual CPT/HCPCS code updates.
Wound Care (L32687)
The following JH MAC Local Coverage Determination (LCD) which was posted for notice on February 6, 2014 is now effective. This LCD has also been revised:
Cataract Extraction (including Complex Cataract Surgery) (L32690)
The following JH MAC LCD has been retired effective March 26, 2014 for dates of service on and after March 27, 2014:
Qualitative Drug Screening (L32666)
The following JH MAC Local Coverage Determination (LCD) is posted for notice and will become effective for dates of service on or after May 1, 2014:
Hemophilia Factor Products (L32735)
The following JH MAC Local Coverage Determinations (LCDs) have been revised:
3D Interpretation and Reporting of Imaging Studies (L32602)
Implantable Infusion Pump (L32740)
The following JH MAC Local Coverage Determination (LCD) has been retired effective for dates of service on and after 11/01/2013.
Pathology and Laboratory: B-type Natriuretic Peptide (BNP) Testing (L32618)
The comment period is now closed for the JH MAC Draft Local Coverage Determinations (LCDs) listed below. The comments received are being reviewed by our Contractor Medical Directors.
Autonomic Function Tests (DL34788)
Biomarkers for Oncology (DL34796)
Chiropractic Services (DL34816)
Hyperbaric Oxygen (HBO) Therapy (DL34794)
Independent Diagnostic Testing Facility (IDTF) (DL34792)
Magnetic Pelvic Floor Stimulation (MPFS) (DL34612)
Multiple Imaging in Oncology (DL34790)
Non-Invasive Cerebrovascular Arterial Studies (DL34711)
Non-Invasive Peripheral Venous Studies (DL34714)
Non-Vascular Extremity Ultrasound (DL34716)
Bioengineered Skin Substitutes (L32622)
Biomarkers for Oncology (L33138)
Biomarkers Overview (L33638)
Cardiovascular Nuclear Medicine (L32635)
Category III Codes (L32691)
Cosmetic and Reconstructive Surgery (L32763)
Diagnostic Abdominal Aortography and Renal Angiography (L32709)
Frequency of Laboratory Tests (L32731)
Glaucoma Treatment with Aqueous Drainage Device (L32733)
Hemophilia Factor Products (L32735)
Interventional Cardiology (L32603)
Intravenous Immune Globulin (IVIG) (L32712)
Non-Coronary Vascular Stents (L32641)
Pain Management of Peripheral Nerves by Injection (L33604)
Partial Hospitalization Programs (PHPs) - Psychiatric (L32705)
Psychiatric Codes (L32766)
Surgery: Blepharoplasty (L32715)
Thrombolytic Agents (L32756)
Upper Gastrointestinal Endoscopy (Diagnostic And Therapeutic) (L32681)
Vascular Access for Hemodialysis (L32708)
Wound Care and Cellular and/or Tissue-Based Products for Wounds (CTPs) (L32687)
Nerve Conduction Studies and Electromyography (L32723)
Pain Management (L32702)
Approved Drugs and Biologicals; Includes Cancer Chemotherapeutic Agents (A52018)
Biomarkers for Oncology (A52317)
Self-Administered Drug Exclusion List (A51866)
The release of the LCDs and Articles revised based on the 2014 annual coding update has been delayed. The revised LCDs and Articles will be available on February 27, 2014 on the Medicare Coverage Database and the Novitas web site within the Medical Policy Center under the Latest LCD Updates link. We apologize for any inconvenience.
LCDs and Articles affected by the 2014 annual coding updates:
L32603 Interventional Cardiology
L32622 Bioengineered Skin Substitutes
L32635 CARDIOVASCULAR NUCLEAR MEDICINE
L32641 NON-CORONARY VASCULAR STENTS
L32681 UPPER GASTROINTESTINAL ENDOSCOPY
L32687 WOUND CARE
DL32687 WOUND CARE
L32691 CATEGORY III CODES
L32705 PARTIAL HOSPITALIZATION PROGRAMS (PHPS) PSYCHIATRIC
L32708 Vascular Access for Hemodialysis
DL32708 Vascular Access for Hemodialysis
L32709 DIAGNOSTIC ABDOMINAL AORTOGRAPHY AND RENAL ANGIOGRAPHY
L32712 INTRAVENOUS IMMUNE GLOBULIN
L32715 BLEPHAROPLASTY
DL32715 BLEPHAROPLASTY
L32723 Nerve Conduction/EMG Studies (Electrodiagnostic)
L32731 Frequency of Laboratory Tests
L32733 GLAUCOMA TREATMENT WITH AQUEOUS DRAINAGE DEVICE
L32735 HEMOPHILIA FACTOR PRODUTCTS
L32756 THROMBOLYTIC AGENTS
L32763 COSMETIC AND RECONSTRUCTIVE SURGERY
L32766 PSYCHIATRIC CODES
L33138 Biomarkers for Oncology
A52317 Biomarkers for Oncology
L33638 Biomarkers Overview
L33604 Pain Management of Peripheral Nerves by Injection
A51866 SELF ADMINISTERED DRUG EXCLUSION LIST
Bariatric Surgical Management of Morbid Obesity (L32619)
Frequency of Dialysis (L32755)
Infrared Photocoagulation (IRC) of Hemorrhoids (L34350)
Intraoperative Neurophysiological Testing (L32605)
Outpatient Sleep Studies (L32711)
Qualitative Drug Testing (L34352)
Surgery: Blepharoplasty (L32715)
Vascular Access for Hemodialysis (L32708)
Wound Care and Cellular and/or Tissue-Based Products for Wounds (CTPs) (L32687) (formerly titled Wound Care and Bioengineered Skin Substitutes)
Comments Received and Contractor Responses
Hemophilia Factor Products (L32735)
Cataract Extraction (including Complex Cataract Surgery) (L32690)
Glaucoma Treatment with Aqueous Drainage Device (L32733)
Lacrimal Punctum Plugs (L32607)
Wireless Capsule Endoscopy (L32686)
Autonomic Function Tests (DL34788)
Biomarkers for Oncology (DL34796)
Chiropractic Services (DL34816)
Hyperbaric Oxygen (HBO) Therapy (DL34794)
Independent Diagnostic Testing Facility (IDTF) (DL34792)
Magnetic Pelvic Floor Stimulation (MPFS) (DL34612)
Multiple Imaging in Oncology (DL34790)
Non-Invasive Cerebrovascular Arterial Studies (DL34711)
Non-Invasive Peripheral Venous Studies (DL34714)
Non-Vascular Extremity Ultrasound (DL34716)
Submit Comments
The following list of LCDs and Local Coverage Articles (Articles) are currently under revision based on the 2014 annual coding update. The revisions will be effective for dates of service on and after January 1, 2014. The revised LCDs and Articles will be available for review February 13, 2014 on the Medicare Coverage Database and the Novitas web site within the Medical Policy Center under the Latest LCD Updates link.
L32603 - Interventional Cardiology
L32622 - Bioengineered Skin Substitutes
L32635 - CARDIOVASCULAR NUCLEAR MEDICINE
L32641 - NON-CORONARY VASCULAR STENTS
L32681 - UPPER GASTROINTESTINAL ENDOSCOPY
L32687 - WOUND CARE
DL32687 - WOUND CARE
L32691 - CATEGORY III CODES
L32705 - PARTIAL HOSPITALIZATION PROGRAMS (PHPS) PSYCHIATRIC
L32708 - Vascular Access for Hemodialysis
DL32708 - Vascular Access for Hemodialysis
L32709 - DIAGNOSTIC ABDOMINAL AORTOGRAPHY AND RENALANGIOGRAPHY
L3212 - INTRAVENOUS IMMUNE GLOBULIN
L32715 - BLEPHAROPLASTY
DL32715 - BLEPHAROPLASTY
L32723 - Nerve Conduction/EMG Studies (Electrodiagnostic)
L32731 - Frequency of Laboratory Tests
L32733 - GLAUCOMA TREATMENT WITH AQUEOUS DRAINAGE DEVICE
L32735 - HEMOPHILIA FACTOR PRODUTCTS
L32756 - THROMBOLYTIC AGENTS
L32763 - COSMETIC AND RECONSTRUCTIVE SURGERY
L32766 - PSYCHIATRIC CODES
L33138 - Biomarkers for Oncology
A52317 - Biomarkers for Oncology
L33638 - Biomarkers Overview
L33604 - Pain Management of Peripheral Nerves by Injection
A51866 - SELF ADMINISTERED DRUG EXCLUSION LIST
The following JH MAC Local Coverage Determinations (LCDs) which were posted for notice on October 10, 2013 are now effective:
Biomarkers Overview (L33638)
Molecular Diagnostics: Genitourinary Infectious Disease Testing (L33644)
Neuromuscular Junction Testing (L33650)
Pain Management of Peripheral Nerves by Injection (L33604)
Scanning Computerized Ophthalmic Diagnostic Imaging (L33590)
Transcranial Magnetic Stimulation (TMS) for the Treatment of Depression (L33660)
Trigger Point Injections (L33648)
The following JH MAC Local Coverage Determination (LCD) has been revised:
Vertebroplasty, Vertebral Augmentation, Percutaneous (L32685)
The following JH MAC Local Coverage Determination (LCD) has been retired for dates of service on and after December 5, 2013:
Transcranial Magnetic Stimulation for Depression (L32752)
The comment period is now closed for the following JH MAC Draft Local Coverage Determinations (LCDs). The comments received are being reviewed by our Contractor Medical Directors.
Bariatric Surgical Management of Morbid Obesity (DL32619)
Frequency of Dialysis (DL32755)
Infrared Photocoagulation (IRC) of Hemorrhoids (DL34350)
Intraoperative Neurophysiological Testing (DL32605)
Outpatient Sleep Studies (DL32711)
Qualitative Drug Testing (DL34352)
Surgery: Blepharoplasty (DL32715)
Vascular Access for Hemodialysis (DL32708)
Wound Care and Bioengineered Skin Substitutes (DL32687)
The comment period will close on November 7, 2013 for the following JH MAC Draft Local Coverage Determinations (LCDs):
Bariatric Surgical Management of Morbid Obesity (DL32619)
Frequency of Dialysis (DL32755)
Infrared Photocoagulation (IRC) of Hemorrhoids (DL34350)
Intraoperative Neurophysiological Testing (DL32605)
Outpatient Sleep Studies (DL32711)
Qualitative Drug Testing (DL34352)
Surgery: Blepharoplasty (DL32715)
Vascular Access for Hemodialysis (DL32708)
Wound Care and Bioengineered Skin Substitutes (DL32687)
Submit Comments
The Jurisdiction H Local Coverage Determinations (LCDs) listed below have been retired effective for dates of service on and after November 1, 2013. In the absence of a Local Coverage Determination (LCD), National Coverage Determination (NCD), or CMS Manual Instruction, Reasonable and Necessary guidelines still apply. Section 1862(a)(1)(A) of the Social Security Act (SSA) directs the following:
“No payment may be made under Part A or Part B for any expenses incurred for items or services not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.”
Therefore, to be considered “reasonable and necessary” the patient’s medical record must clearly document all of the following:
The item or service is for the diagnosis or treatment, or to improve the functioning of a malformed body member
The item or service is appropriate for the symptoms and diagnosis or treatment of the patient’s condition, illness, disease or injury
The item or service is furnished in accordance with current standards of good medical practice
The item or service is not primarily for the convenience of the patient or physician or health care provider
The item or service is the most appropriate supply or level of service that can be safely provided to the patient
The item or service is delivered in the most appropriate setting
The item or service is ordered and/or furnished by qualified personnel
For any service reported to Medicare, it is expected that the medical record documentation clearly demonstrates that the service meets all of the above criteria. All documentation must be maintained in the patient’s medical record and be available to the contractor upon request.
LCDs retired effective for dates of service on and after November 1, 2013:
Allergen Immunotherapy (L32604)
Automatic Implantable Cardiac Defibrillator (AICD) (L32617)
Bone Mass Measurement (L32623)
Cardiac Catheterization (L32676)
Cardiac Output Monitoring by Electrical Bioempedance (L32684)
Cardiac Rehabilitation and Intensive Cardiac Rehabilitation (L32688)
Cardiovascular Stress Testing (L32689)
Chelation Therapy (L32692)
Chest X-Ray (L32693)
Collagenase Clostridium Histolyticum Injections (L32719)
Colonoscopy , Diagnostic (L32695)
Complex Decongestive Physiotherapy (CDP) for Lymphedema (L32698)
Computed Cardiac Tomography (CCT) and Computed Tomography Coronary Angiography (CTCA) (L32750)
Computed Tomography (CT) Colonography (L32696)
Computed Tomography of the Thorax (L32703)
Drugs and Biologicals: Colony Stimulating Factors (L32697)
Electrocardiogram (ECG or EKG) (L32721)
Erythropoiesis Stimulating Agents (ESAs) Non-Dialysis (L32720)
External Counterpulsation (ECP) (L32728)
Grenz Ray Treatment (L32734)
Holter Monitoring (L32736)
Inhalation Therapy (L32741)
Intensity Modulated Radiation Therapy (IMRT) (L32742)
Interspinous Process Decompression (L32594)
Mammography, Diagnostic (L32612)
Medicine: Health and Behavior Assessment/Intervention (L32664)
MRI & CT Scans of the Head, Neck and Brain (L32632)
MRI & CT Scans of the Spine (L32633)
MRI of a Joint (L32761)
Non Invasive Vascular Studies (L32754)
Outpatient Intermittent Inotropic Therapy for Heart Failure (L32699)
Pulmonary Rehabilitation (PR) Programs (L32764)
Pulmonary Stress Testing (L32765)
Radiology: Computed Tomography of the Abdomen and Pelvis (L32701)
Radiopharmaceuticals: Monoclonal Antibodies, Diagnostic (L32667)
Respiratory Therapy (L32747)
Respiratory Therapy Rehabilitation (L32748)
Special Electroencephalography (EEG) (L32717)
Stereotactic Body Radiation Therapy (L32670)
Stereotactic Radiosurgery/Stereotactic Body Radiation Therapy: Cranial Lesions (L32671)
Stress Echocardiography (L32716)
Surgery: Continuous Peripheral Nerve Blocks (CPNB) (L32639)
Thermotherapies (Minimally Invasive Surgical Techniques (MISTs) for Benign Prostatic Hyperplasia (BPH) (L32672)
Transcatheter Therapy – Other Than Thrombolysis, Chemotherapy or Embolization (L32760)
Vagus Nerve Stimulation (L32682)
Vertebral Fracture Assessment (VFA) (L32683)
The following JH MAC Local Coverage Determinations (LCDs) have been posted for notice. They will become effective December 5, 2013:
Biomarkers Overview (L33638)
Molecular Diagnostics: Genitourinary Infectious Disease Testing (L33644)
Neuromuscular Junction Testing (L33650)
Pain Management of Peripheral Nerves by Injection (L33604)
Scanning Computerized Ophthalmic Diagnostic Imaging (L33590)
Transcranial Magnetic Stimulation (TMS) for the Treatment of Depression (L33660)
Trigger Point Injections (L33648)
Comments Received and Contractor Responses
The following JH MAC Draft Local Coverage Determinations (LCDs) have been posted for comment. The comment period ends on November 7, 2013.
Bariatric Surgical Management of Morbid Obesity (DL32619)
Frequency of Dialysis (DL32755)
Infrared Photocoagulation (IRC) of Hemorrhoids (DL34350)
Intraoperative Neurophysiological Testing (DL32605)
Outpatient Sleep Studies (DL32711)
Qualitative Drug Testing (DL34352)
Surgery: Blepharoplasty (DL32715)
Vascular Access for Hemodialysis (DL32708)
Wound Care and Bioengineered Skin Substitutes (DL32687)
Submit Comments
The following JH MAC Draft LCD which was posted for comment on May 28, 2013 will not be finalized and is retired effective September 16, 2013. Please refer to DL32687 posted for comment on September 17, 2013 (see above):
Wound Care and Bioengineered Skin Substitutes (DL32687)
The following JH MAC Local Coverage Determinations (LCDs) have been revised:
Cataract Extraction (including Complex Cataract Surgery) (L32690)
Category III Codes (L32691)
Moh’s Micrographic Surgery (MMS) (L32627)
MRI and CT Scans of the Head, Neck and Brain (L32632)
Prostate Mapping Biopsy (L32665)
Psychiatric Codes (L32766)
The following JH MAC Article has been revised:
NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Oncologic Conditions (A52203)
The following JH MAC Local Coverage Determinations (LCDs) which were posted for notice on June 13, 2013 are now effective:
Anorectal Manometry, Anal Electromyography, and Biofeedback Training for Perineal Muscles and Anorectal or Urethral Sphincters (L33140)
Biomarkers for Oncology (L33138) (Please note this LCD has also undergone a minimal non-restrictive revision)
Implantable Infusion Pump (L32740) (Please note this LCD has also undergone a minimal non-restrictive revision)
Nerve Conduction Studies and Electromyography (L32723)
Real-Time, Outpatient Cardiac Telemetry (L33075)
Surgery: Posterior Tibial Nerve Stimulation (PTNS) for Urinary Control (L32751)
The following JH MAC Articles have been added:
Biomarkers for Oncology (A52316)
Real-Time Outpatient Cardiac Telemetry (A52298)
The following JH MAC draft LCD has been retired effective 08/01/2013:
Proton Beam Therapy (DL33093)
The comment period is now closed for the following JH MAC Draft Local Coverage Determinations (LCDs). The comments received are being reviewed by our Contractor Medical Directors.
Biomarkers Overview (DL33638)
Molecular Diagnostics: Genitourinary Infectious Disease Testing and Other Applications for Amplified Probe Testing (DL33644)
Neuromuscular Junction Testing (DL33650)
Pain Management of Peripheral Nerves by Injection (DL33604)
Scanning Computerized Ophthalmic Diagnostic Imaging (DL33590)
Transcranial Magnetic Stimulation (TMS) for the Treatment of Depression (DL33660)
Trigger Point Injections (DL33648)
Wound Care and Bioengineered Skin Substitutes (DL32687)
The comment period will close on July 18, 2013 for the following JH MAC Draft Local Coverage Determinations (LCDs):
Biomarkers Overview (DL33638)
Molecular Diagnostics: Genitourinary Infectious Disease Testing and Other Applications for Amplified Probe Testing (DL33644)
Neuromuscular Junction Testing (DL33650)
Pain Management of Peripheral Nerves by Injection (DL33604)
Scanning Computerized Ophthalmic Diagnostic Imaging (DL33590)
Transcranial Magnetic Stimulation (TMS) for the Treatment of Depression (DL33660)
Trigger Point Injections (DL33648)
Wound Care and Bioengineered Skin Substitutes (DL32687)
Submit Comments
The following JH MAC Local Coverage Determinations (LCDs) have been revised:
Assays for Vitamins and Metabolic Function (L32614)
Bariatric Surgical Management of Morbid Obesity (L32619)
Non Invasive Vascular Studies (L32754)
Prostate Mapping Biopsy (L32665)
Pulmonary Function Testing (L32762)
The following JH MAC Local Coverage Determination (LCD) has been retired effective for dates of service on and after January 18, 2013:
Botulinum Toxin Types A and B (L32624)
The following JH MAC Local Coverage Determinations (LCDs) have been revised:
Assays for Vitamins and Metabolic Function (L32614)
Barium Swallow Studies, Modified (L32621)
Category III Codes (L32691)
Cosmetic and Reconstructive Surgery (L32763)
Therapy Services (PT, OT, SLP) (L32710)
The following JH MAC Local Coverage Determinations (LCDs) have been posted for notice. They will become effective August 1, 2013:
Anorectal Manometry, Anal Electromyography, and Biofeedback Training for Perineal Muscles and Anorectal or Urethral Sphincters (L33140)
Biomarkers for Oncology (L33138)
Implantable Infusion Pump (L32740)
Nerve Conduction Studies and Electromyography (L32723)
Real-Time, Outpatient Cardiac Telemetry (L33075)
Surgery: Posterior Tibial Nerve Stimulation (PTNS) for Urinary Control (L32751)
Comments received and Contractor Responses
The following JH MAC draft LCD is on hold. When it is finalized, it will be posted for a 45-day notice period before becoming effective:
Proton Beam Therapy (DL33093)
The following JH MAC Draft Local Coverage Determinations (LCDs) have been posted for comment. The comment period ends on July 18, 2013:
Biomarkers Overview (DL33638)
Molecular Diagnostics: Genitourinary Infectious Disease Testing and Other Applications for Amplified Probe Testing (DL33644)
Neuromuscular Junction Testing (DL33650)
Pain Management of Peripheral Nerves by Injection (DL33604)
Scanning Computerized Ophthalmic Diagnostic Imaging (DL33590)
Transcranial Magnetic Stimulation (TMS) for the Treatment of Depression (DL33660)
Trigger Point Injections (DL33648)
Wound Care and Bioengineered Skin Substitutes (DL32687)
The following JH MAC draft Local Coverage Determination (LCD) has been retired effective May 27, 2013. Refer to DL33638 (above) for the current draft LCD posted for comment:
Biomarkers Overview (DL33122)
The following JH MAC Local Coverage Determination (LCD) which was posted for notice on April 9, 2013 becomes effective on May 25, 2013:
Circulating Tumor Cell (CTC) Assay (L33232)
The following JH MAC Local Coverage Determination (LCD) has been retired effective May 24, 2013. Refer to LCD L33232 for dates of service on and after May 25, 2013.
Circulating Tumor Cell Assay (L32694)
The following JH MAC Local Coverage Determinations (LCDs) have been revised:
Bioengineered Skin Substitutes (L32622)
Category III Codes (L32691)
Intensity-Modulated Radiation Therapy (IMRT) (L32742)
Mycotic Nail Debridement (L32634)
The following MAC JH Local Coverage Determination (LCD) has been retired effective for dates of service on and after May 8, 2013:
Positron Emission Tomography (PET) (L32663)
The following JH MAC Local Coverage Articles have been added:
NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Oncologic Conditions (A52203)
NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions (A52202)
The following JH MAC Local Coverage Determination (LCD) has been posted for notice. It will become effective May 25, 2013.
Circulating Tumor Cell (CTC) Assay (L33232)
Local Coverage Determination (LCD) Search Function
Our LCD search function has been improved! Many of our LCDs previously included procedure code ranges. These ranges decreased the reliability of search results when searching for an LCD by procedure code. All procedure code ranges have been removed from the LCDs and replaced with the individual codes. Please note that not every procedure code is included in an LCD.
When searching for an LCD we suggest the use of the Policy Search function at the top of the page.
You can also view the complete listing of Jurisdiction H (JH) LCDs found in the Medical Policy Center under Current Active LCDs JH.
The comment period is now closed for the following JH MAC Draft Local Coverage Determinations (LCDs). The comments received are being reviewed by our Contractor Medical Directors.
Anorectal Manometry, Anal Electromyography, and Biofeedback Training for Perineal Muscles and Anorectal or Urethral Sphincters (DL33140)
Biomarkers for Oncology (DL33138)
Biomarkers Overview (DL33122)
Implantable Infusion Pump (DL32740)
Nerve Conduction Studies and Electromyography (DL32723)
Proton Beam Therapy (DL33093)
Real-Time, Outpatient Cardiac Telemetry (DL33075)
Surgery: Posterior Tibial Nerve Stimulation (PTNS) for Urinary Control (DL32751)
The following JH MAC Local Coverage Determination (LCD) has been retired effective January 18, 2013:
Drugs and Biologicals: Antiangiogenic Therapy for Ophthalmic Conditions (L32642)
The following JH MAC Local Coverage Determination (LCD) has been revised:
Collagenase Clostridium Histolyticum Injections (L32719)
The following JH MAC Local Coverage Determinations (LCDs) have been revised to reflect the Annual CPT/HCPCS Updates effective for dates of service on and after January 1, 2013:
Assays for Vitamins and Metabolic Function (L32614)
Automatic Implantable Cardiac Defibrillator (AICD) (L32617)
Bioengineered Skin Substitutes (L32622)
Botulinum Toxin Types A and B (L32624)
Cardiac Event Detection Monitoring (L32679)
Chest X-Ray (L32693)
Chiropractic Services (L32718)
Circulating Tumor Cell Assay (L32694)
Complex Decongestive Physiotherapy (CDP) for Lymphedema (L32698)
Cosmetic and Reconstructive Surgery (L32763)
Diagnostic Abdominal Aortography and Renal Angiography (L32709)
Electrodiagnostic Studies (NCS/EMG) (L32723)
Extracorpeal Shock Wave Therapy (ESWT) (L32729)
Intravenous Immune Globulin (IVIG) (L32712)
Interventional Cardiology (L32603)
Intraoperative Neurophysiologic Monitoring (L32605)
Monitored Anesthesia Care (L32628)
MRI and CT Scans of the Head, Neck, and Brain (L32632)
Non Invasive Vascular Studies (L32754)
(also updated due to a reconsideration request)
Outpatient Sleep Studies (L32711)
(also updated due to reconsideration requests)
Pain Management (L32702)
Partial Hospitalization Programs (PHPs) – Psychiatric (L32705)
(also updated due to a reconsideration request)
Pathology and Laboratory: B-type Natriuretic Peptide (BNP) Testing (L32618)
Psychiatric Codes (L32766)
Pulmonary Function Testing (L32762)
Routine Foot Care (L32669)
Therapy Services (PT, OT, SLP) (L32710)
Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography (L32673)
Thrombolytic Agents (L32756)
Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic) (L32681)
Vestibular and Audiologic Function Studies (L32767)
Wound Care (L32687)
The following JH MAC Local Coverage Article has been revised to reflect the Annual CPT/HCPCS Updates effective for dates of service on and after January 1, 2013:
Approved Drugs and Biologicals; Includes Cancer Chemotherapeutic Agents (A52018)
The following JH Local Draft Coverage Determinations (LCDs) have been posted for comment. The comment period ends on March 20, 2013:
Anorectal Manometry, Anal Electromyography, and Biofeedback Training for Perineal Muscles and Anorectal or Urethral Sphincters (DL33140)
Biomarkers for Oncology (DL33138)
Biomarkers Overview (DL33122)
Implantable Infusion Pump (DL32740)
Nerve Conduction Studies and Electromyography (DL32723)
Proton Beam Therapy (DL33093)
Real-Time, Outpatient Cardiac Telemetry (DL33075)
Surgery: Posterior Tibial Nerve Stimulation (PTNS) for Urinary Control (DL32751)
The following MAC JH Local Coverage Determination (LCD) has been revised. The revision for this LCD posted on December 21,2012 was in error and the revised version below correctly implements CR 8028 regarding Laparoscopic Sleeve Gastrectomy.
Bariatric Surgical Management of Morbid Obesity (L32619)
The following Provider Bulletin has been issued for MAC JH:
Molecular Pathology Coding Changes for 2013
The following MAC JH Local Coverage Determination (LCD) has been revised:
Bariatric Surgical Management of Morbid Obesity (L32619)
The following MAC JH Local Coverage Determination (LCD) has been revised:
Benign Skin Lesions (L32668)
The following MAC JH Local Coverage Article has been added. It will become effective for dates of service on and after December 17, 2012.
Approved Drugs and Biologicals: Includes Cancer Chemotherapeutic Agents (A52018)
JH Local Coverage Determinations (LCDs) and Self-Administered Drug Exclusion List Effective November 19, 2012 for Colorado Part B, New Mexico Part B, Oklahoma Part B, Texas Part B, Indian Health Service (IHS)/Tribal/Urban Indian Providers Part B, and Veterans Affairs (VA) Part B.
The JH LCDs and the Self-Administered Drug Exclusion List that were posted for notice on June 28, 2012 will become effective for Colorado Part B, New Mexico Part B, Oklahoma Part B, Texas Part B, Indian Health Service (IHS)/Tribal/Urban Indian Providers Part B, and Veterans Affairs (VA) Part B for dates of service on and after November 19, 2012. Per CMS Change Request (CR) 7812, these LCDs have been updated with the original effective date of November 19, 2012 to add the Novitas Jurisdiction H Part B MAC Contract Numbers 04112, 04212, 04312, and 04412. No other changes were made to these LCDs or to the Self-Administered Drug Exclusion List.
JH Self-Administered Drug Exclusion List Revised
Jurisdiction H Article A51866, Local Coverage Article for Self-Administered Drug Exclusion List, has been revised effective for dates of service on and after 08/13/2012 to remove certolizumab pegol (Cimzia) and golimumab (Simponi) from the exclusion list due to the frequency for these injections. The Article was also revised to clarify injection frequency parameters, and to add the Provistin VR and Fortical brand names.
JH Local Coverage Determinations and Self-Administered Drug Exclusion List Effective October 29, 2012 for Colorado Part A, New Mexico Part A, Oklahoma Part A, Texas Part A, Indian Health Service (IHS)/Tribal/Urban Indian Providers Part A, and Veterans Affairs (VA) Part A.
The JH LCDs and the Self-Administered Drug Exclusion List that were posted for notice on June 28, 2012 will become effective for Colorado Part A, New Mexico Part A, Oklahoma Part A, Texas Part A, Indian Health Service (IHS)/Tribal/Urban Indian Providers Part A, and Veterans Affairs (VA) Part A for dates of service on and after October 29, 2012. Per CMS Change Request (CR) 7812, these LCDs have been updated with the original effective date of October 29, 2012 to add the Novitas Jurisdiction H Part A MAC Contract Numbers 04911, 04111, 04211, 04311, and 04411. No other changes were made to these LCDs or to the Self-Administered Drug Exclusion List.
Novitas Solutions’ JH Local Coverage Determinations and Self-Administered Drug Exclusion List Effective October 22, 2012 for Mississippi Part B.
The JH LCDs and the Self-Administered Drug Exclusion List that were posted for notice on June 28, 2012 will become effective for Mississippi Part B for dates of service on and after October 22, 2012. Per CMS Change Request (CR) 7812, these LCDs have been updated with the original effective date of October 22, 2012 to add the Novitas Jurisdiction H Part B MAC Contract Number 07302 for Mississippi Part B. No other changes were made to these LCDs or to the Self-Administered Drug Exclusion List.
Novitas Solutions’ JH Local Coverage Determinations and Self-Administered Drug Exclusion List Effective for Arkansas Part A, Louisiana Part A, and Mississippi Part A
The JH LCDs and Self-Administered Drug Exclusion List that were posted for notice on June 28, 2012 are now effective for Arkansas Part A, Louisiana Part A, and Mississippi Part A for dates of service on and after August 20, 2012.
Novitas Solutions’ JH Local Coverage Determinations and Self-Administered Drug Exclusion List Effective for Arkansas Part B and Louisiana Part B
ISSUED: (08/13/20012 @ 10:15 AM)
The JH LCDs that were posted for notice on June 28, 2012 are now effective for Arkansas Part B and Louisiana Part B.
JH Local Coverage Determinations (LCDs) That Will Not be Implemented
ISSUED: (08/09/20012 @ 5:10 PM)
As part of the JH transition activities, Novitas Solutions has become aware that there is some inconsistency between certain Local Coverage Determinations (LCDs) that were not previously analyzed side by side. As a result, the following LCDs will NOT be implemented:
L32759, Neurophysiological Studies
L32713, Paravertebral Facet Nerve Denervation
L32746, Renal Angiography
L32724, EPO/Darbepoetin Alfa- Preoperative
L32725, EPO/Darbepoetin Alfa For Treatment Of Anemia Associated With AZT Therapy
The above LCDs have been removed from our website and are in-process of removal from the Medicare Coverage Database (MCD). We have also removed reference to these LCDs in the JH LCD/Outgoing Contractor Comparison Crosswalks on the JH Transition webpage.