National Government Services Local Coverage Determinations
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Please note: There are many procedures for which NGS does not have an LCD/Billing and Coding Article. If your search does not return any coverage documents, then NGS does not have a local coverage statement for that procedure.
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Retired LCDs/Coding and Billing Articles]
Local Coverage Determinations
| LCD | LCD # | Billing and Coding # | Response to Comments | Related CPT/HCPCS Codes |
|---|---|---|---|---|
| Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin and Non-Hodgkin Lymphoma with B-cell or T-cell Origin Related terms: |
L39513 | A59311 | A59451 | 38240 |
| Amniotic/Placental-Derived Product Injections/Applications for Musculoskeletal Indications, Non-Wound Related terms: |
L39139 | A58893 | A59578 | Q4139, Q4145, Q4155, Q4162, Q4168, Q4171, Q4174, Q4177, Q4185, Q4189, Q4192, Q4206, Q4212, Q4213, Q4215, Q4230, Q4231, Q4233, Q4240, Q4241, Q4242, Q4244, Q4245, Q4246 |
| Autonomic Function Testing Related terms: tilt table, sudomotor |
L36236 | A57024 | A54403 | 95921, 95922, 95923, 95924, 95999 |
| B-type Natriuretic Peptide (BNP) Testing Related terms: congestive heart failure, acute dyspnea |
L33573 | A56826 | 83880 | |
| Botulinum Toxins Related terms: Botox, Myobloc, Dysport,Xeomin, spasticity, chemodenervation |
L33646 | A52848 | 43201, 43236, 46505, 52287, 64611, 64612, 64615, 64616, 64617, 64642, 64643, 64644, 64645, 64646, 64647, 64650, 64653, 67345, J0585, J0586, J0587, J0588, J0589 | |
| Breast Imaging: Breast Echography (Sonography)/Breast MRI/Ductography Related terms: ultrasound, non-palpable masses, palpable masses |
L33585 | A52849 | 19030, 76641, 76642, 77046, 77047, 77048, 77049, 77053, 77054, C8903, C8905, C8906, C8908 | |
| Cardiac Catheterization and Coronary Angiography Related terms: heart, circulatory |
L33557 | A52850 | 36120, 36140, 36200, 36215, 36216, 36217, 36218, 36245, 36246, 36247, 36248, 36251, 36252, 36253, 36254, 75625, 75630, 75658, 75705, 75710, 75716, 92978, 92979, 93451, 93452, 93453, 93454, 93455, 93456, 93457, 93458, 93459, 93460, 93461, 93462, 93463, 93464, 93505, 93563, 93564, 93565, 93566, 93567, 93568, 93571, 93572, 93593, 93594, 93596, 93597, 93598, G0269, G0278 | |
| Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA) Related terms: heart, calcium, congenital, bypass |
L33559 | A56737 | A58889 | 75571, 75572, 75573, 75574 |
| Cardiovascular Nuclear Medicine Related terms: cardiac scan, stress test, heart, coronary, ejection, perfusion, blood pool |
L33560 | A56743 | 78451, 78452, 78453, 78454, 78466, 78468, 78469, 78472, 78473, 78481, 78483, 78494, 78496, A9500, A9501, A9502, A9505, A9512, A9520, A9538, A9560, Q9969 | |
| Cataract Extraction Related terms: eyes, ophthalmology, complex, epinephrine |
L33558 | A56544 | A55257 | 66840, 66850, 66852, 66920, 66930, 66940, 66982, 66983, 66984, 66987, 66988 |
| Cervical Fusion Related terms: |
L39770 | A59632 | A59772 | 22548, 22551, 22552, 22554, 22590, 22595, 22600, 22800, 22802, 22808, 22810, 22812 |
| Computed Tomographic (CT) Colonography for Diagnostic Uses Related terms: virtual colonoscopy |
L33562 | A57026 | 74261, 74262 | |
| Debridement Services Related terms: N/A |
L33614 | A56617 | 11000, 11001, 11042, 11043, 11044, 11045, 11046, 11047, 97597, 97598 | |
| Drugs and Biologicals, Coverage of, for Label and Off-Label Uses Related terms: administration, compendia, FDA |
L33394 | A52855 | A59216 | |
| EEG – Ambulatory Monitoring Related terms: electroencephalogram |
L33399 | A57030 | 95700, 95705, 95706, 95707, 95708, 95709, 95710, 95711, 95712, 95713, 95714, 95715, 95716, 95717, 95718, 95719, 95720, 95721, 95722, 95723, 95724, 95725, 95726 | |
| Epidural Steroid Injections for Pain Management Related terms: spine, pain, transforaminal, sacral, steroid, spinal |
L39036 | A58745 | A58912 | 62320, 62321, 62322, 62323, 64479, 64480, 64483, 64484 |
| Facet Joint Interventions for Pain Management Related terms: Radiofrequency, Neurotomy, pain, cervical, lumbar, thoracic |
L35936 | A57826 | A58658 | 64490, 64491, 64492, 64493, 64494, 64495, 64633, 64634, 64635, 64636, 64625 |
| Frequency of Hemodialysis Related terms: dialysis, kidney disease, end stage renal disease |
L37475 | A55672 | A56252 | 90999 |
| Genomic Sequence Analysis Panels in the Treatment of Hematolymphoid Diseases Related terms: N/A |
L37606 | A56793 | A55974 | 81450, 81451 |
| Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms Related terms: N/A |
L37810 | A56867 | A58984 | A56867, 0048U, 0250U, 81445, 81455, 81449, 81456 |
| Heavy Metal Testing Related terms: metal toxicity, aluminum, arsenic, iron, lead, nickel, zinc, mercury |
L35074 | A56767 | A58628 | 82108, 82175, 82300, 82495, 82525, 83015, 83018, 83655, 83785, 83825, 83885, 84255, 84285, 84630, 84999 |
| Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea Related terms: N/A |
L38387 | A57092 | 64582, 64583, 64584 | |
| Implantable Continuous Glucose Monitors (I-CGM) Related terms: N/A |
L38623 | A58116 | A58342 | 0446T, 0447T, 0448T |
| Incision and Drainage (I & D) of Abscess of Skin, Subcutaneous and Accessory Structures Related terms: paronychia, skin, carbuncle, boil |
L33563 | A56766 | 10060, 10061, 10080, 10081, 10140, 10160, 10180 | |
| Magnetic Resonance Angiography (MRA) Related terms: gadolinium, contrast, imaging |
L33633 | A56747 | 70544, 70545, 70546, 70547, 70548, 70549, 71555, 72159, 72198, 73225, 73725, 74185, C8900, C8901, C8902, C8909, C8910, C8911, C8912, C8913, C8914, C8918, C8919, C8920, C8931, C8932, C8933, C8934, C8935, C8936 | |
| Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Tremor Related terms: N/A |
L37421 | A57435 | A58546 | 0398T |
| Mass Spectrometry (MS) Testing in Monoclonal Gammopathy (MG) Related terms: |
L39189 | A58921 | A59078 | 0077U |
| Micro-Invasive Glaucoma Surgery (MIGS) Related terms: N/A |
L37244 | A56588 | A59912 | 0253T, 0449T, 0450T, 0474T, 0671T, 66183, 66989, 66991 |
| Minimally-invasive Surgical (MIS) Fusion of the Sacroiliac (SI) Joint Related terms: iFuse |
L36406 | A57431 | 27279 | |
| Molecular Pathology Procedures Related terms: genetic testing, genetic counseling, gene, Tier 1, Tier 2 |
L35000 | A56199 | A55982 | 81120, 81121, 81162, 81163, 81164, 81165, 81166, 81167, 81170, 81175, 81176, 81206, 81207, 81208, 81209, 81210, 81212, 81215, 81216, 81217, 81218, 81219, 81220, 81221, 81222, 81223, 81224, 81225, 81226, 81235, 81236, 81237, 81245, 81246, 81256, 81261, 81262, 81263, 81264, 81265, 81266, 81267, 81268, 81270, 81272, 81273, 81275, 81276, 81287, 81301, 81305, 81307, 81308, 81309, 81310, 81311, 81314, 81315, 81316, 81332, 81334, 81335, 81340, 81341, 81342, 81345, 81370, 81371, 81372, 81373, 81374, 81375, 81376, 81377, 81378, 81379, 81380, 81381, 81382, 81383, 81518, 81519, 81520, 81595, 81177, 81178, 81179, 81180, 81181, 81182, 81183, 81184, 81185, 81186, 81187, 81188, 81189, 81190, 81233, 81288, 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299, 81300, 81306, 81312, 81317, 81318, 81319, 81320, 81321, 81322, 81323, 81333, 81343, 81344, 81599, 81105‒81112, 81161, 81171, 81172, 81173, 81174, 81200, 81201, 81202, 81203, 81204, 81205, 81227, 81228, 81229, 81230, 81231, 81232, 81234, 81238, 81239, 81240, 81241, 81242, 81243, 81244, 81247, 81248, 81249, 81250, 81251, 81252, 81253, 81254, 81255, 81257, 81258, 81259, 81260, 81269, 81271, 81274, 81277, 81283, 81284, 81285, 81286, 81289, 81290, 81291, 81302, 81303, 81304, 81324, 81325, 81326, 81327, 81328, 81329, 81330, 81331, 81336, 81337, 81346, 81349, 81350, 81355, 81361‒81364, 81410, 81411, 81412, 81413, 81414, 81415, 81416, 81417, 81418, 81420, 81422, 81425, 81426, 81427, 81430, 81431, 81432, 81433, 81434, 81435, 81436, 81437, 81438, 81439, 81440, 81441, 81442, 81443, 81448, 81455, 81460, 81465, 81470, 81471, 81493, 81500, ,81503, 81504, 81507, 81521, 81522, 81523, 81525, 81535, 81536, 81538, 81540, 81541, 81542, 81545, 81551, 81552 |
| Multimarker Serum Tests Related to Ovarian Cancer Testing Related terms: N/A |
L38371 | A57020 | A58112 | 81500, 81503, 0003U |
| Multiplex Gastrointestinal Pathogen Panel (GPP) Tests for Acute Gastroenteritis (AGE) Related terms: |
L39226 | A58963 | A59088 | 87505, 87506, 87507 |
| Nerve Conduction Studies and Electromyography Related terms: electrodiagnostic, neurologic, EMG, NCS, neuromuscular, motor, needle |
L35098 | A57668 | 51785, 92265, 95860, 95861, 95863, 95864, 95865, 95866, 95867, 95868, 95869, 95870, 95872, 95873, 95874, 95885, 95886, 95887, 95905, 95907, 95908, 95909, 95910, 95911, 95912, 95913, 95933, 95937, 95999, G0255 | |
| Non-Invasive Fractional Flow Reserve (FFR) for Stable Ischemic Heart Disease Related terms: |
L39075 | A58814 | A59327 | 75580 |
| Noninvasive Vascular Studies Related terms: NonInvasive, leg, clot, plethysmography, duplex scan, Doppler, cerebrovascular, arterial, venous, hemodialysis |
L33627 | A56758 | 93880, 93882, 93886, 93888, 93890, 93892, 93893, 93922, 93923, 93924, 93925, 93926, 93930, 93931, 93970, 93971, 93975, 93976, 93978, 93979, 93970, 93971, 93985, 93986, 93990 | |
| Off-Label Use of Intravenous Immune Globulin (IVIG) Related terms: |
L39314 | A59105 | A59251 | 96365, 96366, J1459, J1554, J1556, J1557, J1561, J1566, J1568, J1569, J1572, J1599 |
| Off-label Use of Rituximab and Rituximab Biosimilars Related terms: |
L39297 | A59101 | A59213 | J9312, Q5115, Q5119, Q5123 |
| Ophthalmic Biometry for Intraocular Lens Power Calculation Related terms: cataract, biometry, eyes |
L33621 | A56549 | 76519, 92136 | |
| Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography) Related terms: retinal, retinopathy, chorioretinitis, vitreous |
L33567 | A56726 | 92201, 92202, 92227, 92228, 92250 | |
| Osteopathic Manipulative Treatment Related terms: somatic, skeletal, dysfunction |
L33616 | A56954 | A55318 | 98925, 98926, 98927, 98928, 98929 |
| Outpatient Physical and Occupational Therapy Services Related terms: maintenance, restorative, skilled, modality, therapeutic, exercise, manual, cast, splint, biofeedback |
L33631 | A56566 | 29065, 29075, 29085, 29086, 29105, 29125, 29126, 29130, 29131, 29200, 29240, 29260, 29280, 29345, 29355, 29365, 29405, 29425, 29445, 29505, 29515, 29520, 29530, 29540, 29550, 29580, 29799, 90901, 90912, 90913, 95851, 95852, 95992, 96125, 97010, 97012, 97016, 97018, 97022, 97024, 97026, 97028, 97032, 97033, 97034, 97035, 97036, 97039, 97110, 97112, 97113, 97116, 97124, 97129, 97130, 97139, 97140, 97150, 97161, 97162, 97163, 97164, 97165, 97166, 97167, 97168, 97530, 97533, 97535, 97537, 97542, 97602, 97605, 97606, 97607, 97608, 97750, 97755, 97760, 97761, 97763, 97799, G0281, G0283, G0295, G0329 | |
| Pain Management Related terms: spine, spinal, trigger, injection, ganglion |
L33622 | A52863 | A59302 | 20526, 20550, 20551, 20560, 20561, 20612, 28899 |
| Percutaneous Coronary Intervention Related terms: heart, angina, intracoronary |
L33623 | A56823 | 92920, 92921, 92924, 92925, 92928, 92929, 92933, 92934, 92937, 92938, 92941, 92943, 92944, 92973, 92975, 92978, 92979, 93571, 93572, C9600, C9601, C9602, C9603, C9604, C9605, C9606, C9607, C9608 | |
| Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF) Related terms: compression, spine, fracture |
L33569 | A56178 | A58445 | 22510, 22511, 22512, 22513, 22514, 22515, 76380 |
| Peripheral Nerve Blocks Related terms: N/A |
L36850 | A57452 | A55421 | 64400, 64405, 64415, 64416, 64417, 64418, 64420, 64421, 64425, 64430, 64445, 64446, 64447, 64448, 64449, 64450, 64455, 64454, 64624, 20560, 20561 |
| Posterior Tibial Nerve Stimulation for Voiding Dysfunction Related terms: overactive bladder, urinary urgency, urinary frequency, urinary incontinence, percutaneous electrical stimulation |
L33396 | A57453 | 64566 | |
| Proton Beam Therapy Related terms: radiation, radiotherapy |
L35075 | A56827 | A55124 | 77520, 77522, 77523, 77525 |
| Psychiatric Partial Hospitalization Programs Related terms: mental illness, family counseling, vocational training |
L33626 | A56850 | 90785, 90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838, 90846, 90847, 90849, 90853, 90899, 96101, 96102, 96103, 96116, 96118, 96119, 96120, G0129, G0176, G0177, G0410, G0411 | |
| Psychiatry and Psychology Services Related terms: psychiatric, mental illness, Psychotherapy, electroconvulsive therapy, ECT, psychological testing, vocational training, dementia |
L33632 | A56937 | 90785, 90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838, 90839, 90840, 90845, 90846, 90847, 90849, 90853, 90863, 90865, 90870, 90880, 90885, 90887, 90889, 90899, 96105, 96112, 96113, 96116, 96121, 96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139, 96146, G0451 | |
| RAST Type Tests Related terms: FAST, Radioallergosorbent, fluoroallergosorbent, antigen, allergen, IGE |
L33591 | A56844 | 86001, 86003, 86005, 86008 | |
| Reduction Mammaplasty Related terms: breast reconstruction, cosmetic surgery |
L35001 | A56837 | 19316, 19318 | |
| Respiratory Pathogen Panel Testing Related terms: N/A |
L39027 | A58741 | A58890 | 87428, 87631, 87636, 87637, 0240U, 0241U, 87632, 87633, 0115U, 0202U, 0223U, 0225U |
| Routine Foot Care and Debridement of Nails Related terms: feet, toes, toenails, corns, calluses, trimming of nails, systemic disease |
L33636 | A57759 | 11055, 11056, 11057, 11719, 11720, 11721, G0127 | |
| Sacroiliac Joint Injections and Procedures Related terms: |
L39455 | A59233 | A59319 | 27096, 64451, 64625, 77002, 77012, G0260 |
| Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI) Related terms: OCT, eyes, cornea, glaucoma |
L34380 | A56537 | 92132, 92133, 92134 | |
| Select Minimally Invasive GERD Procedures Related terms: N/A |
L35080 | A56863 | A58614 | 43210, 43257, 43284, 43499, 43999, 49999 |
| Speech-Language Pathology Related terms: dysphagia, swallowing, communication |
L33580 | A52866 | 31579, 92507, 92508, 92521, 92522, 92523, 92524, 92597, 92607, 92608, 92609, 92626, 92627, 96105, 96110, 96112, 96113, 97129, 97130, 97533, G0451 | |
| Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT) Related terms: ionizing, stereotactic guidance, robotic |
L35076 | A56874 | 77371, 77372, 77373, 77432, 77435, G0339, G0340 | |
| Total Joint Arthroplasty Related terms: Knee, TKA, Hip, THA |
L36039 | A57428 | 27130, 27132, 27134, 27137, 27138, 27445, 27447, 27486, 27487 | |
| Transcranial Magnetic Stimulation Related terms: depression, major depressive disorder, magnetic field |
L33398 | A57528 | A59328 | 90867, 90868, 90869 |
| Transesophageal Echocardiography (TEE) Related terms: ultrasound, esophagus, doppler, color flow, contrast, heart |
L33579 | A52868 | 76376, 76377, 93312, 93313, 93314, 93315, 93316, 93317, 93318, 93319, 93320, 93321, 93325, C8925, C8926, C8927 | |
| Transthoracic Echocardiography (TTE) Related terms: cardiac, doppler, stress, cardovascular, myocardial, heart, contrast |
L33577 | A56781 | 76376, 76377, 93303, 93304, 93306, 93307, 93308, 93319, 93320, 93321, 93325, 93350, 93351, 93352, A9700, C8921, C8922, C8923, C8924, C8928, C8929, C8930, J0153, J0280, J0461, J1245, J1250, J2785, Q9955, Q9956, Q9957 | |
| Urine Drug Testing Related terms: |
L39611 | A59416 | A59581 | 80305, 80306, 80307, G0480, G0481, G0482, G0483, G0659 |
| Urodynamics Related terms: cystometrogram, uroflowmetry, urethral pressure profile, sphincter electromyogram, sphincter electromyogram, incontinence, voiding dysfunction |
L33576 | A57455 | 51726, 51727, 51728, 51729, 51736, 51741, 51792, 51797 | |
| Varicose Veins of the Lower Extremity, Treatment of Related terms: telangiectasia, spider veins, cosmetic, ligation and stripping, Endovenous radiofrequency ablation, EFRA, laser ablation |
L33575 | A52870 | A55704 | 36465, 36466, 36468, 36470, 36471, 36473, 36474, 36475, 36476, 36478, 36479, 36482, 36483, 37700, 37718, 37722, 37735, 37760, 37761, 37765, 37766, 37780, 37799 |
| Venous Angioplasty with or without Stent Placement for the Treatment of Chronic Cerebrospinal Venous Insufficiency Related terms: CCSVI, multiple sclerosis, MS |
L35028 | A56845 | 37248, 37249 |
Medical Policy Articles
| Article Title | Article # | Related CPT/HCPCS Codes |
|---|---|---|
| Billing and Coding: Arthroscopic Lavage and Arthroscopic Debridement for the Osteoarthritic Knee – Medical Policy Article Related Terms: injection |
A52369 | 29877, 29999, G0289 |
| Billing and Coding: Bevacizumab and Biosimilars Related Terms: drug, retinal |
A52370 | A52370, C9257, J9035, Q5126, Q5129, 67028 |
| Billing and Coding: Denosumab (Prolia ™, Xgeva ™) Related Terms: drug, bone |
A52399 | J0897 |
| Billing and Coding: Eculizumab Related Terms: drug, hemolysis |
A54548 | J1300 |
| Billing and Coding: Hyaluronans Intra-articular Injections of Related Terms: drug, knee, ankle |
A52420 | J7318, J7320, J7321, J7322, J7323, J7324, J7325, J7326, J7327, J7328, J7329, 20610, 20611 |
| Billing and Coding: Ibandronate Sodium Related Terms: drug, bone, osteoporosis |
A52421 | J1740 |
| Billing and Coding: Implantable Automatic Defibrillators Related Terms: N/A |
A56326 | 33202, 33203, 33215, 33216, 33217, 33218, 33220, 33223, 33224, 33225, 33230, 33231, 33240, 33241, 33243, 33244, 33249, 33262, 33263, 33264, 33270, 33271, 33272, 33273, G0448 |
| Billing and Coding: Infliximab and biosimilars Related Terms: drug |
A52423 | J1745, Q5103, Q5104 |
| Billing and Coding: IUD (Hormone-Eluting) for Endometrial Hyperplasia - CPT 58999 Related Terms: N/A |
A58649 | 58999 |
| Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs Related Terms: drug, endometriosis, leuprolide, goserelin |
A52453 | 11981, 11982, 11983, 96402, J1950, J1952, J1954, J3315, J3316, J9202, J9217, J9218, J9219, J9225 |
| Billing and Coding: Off-Label Use of Intravenous Immune Globulin (IVIG) Related Terms: |
A59105 | J1459, J1554, J1556, J1557, J1561, J1566, J1568, J1569, J1572, J1576, J1599 |
| Billing and Coding: Omalizumab Related Terms: drug |
A52448 | J2357 |
| Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™) Related Terms: drug |
A52450 | J9264, J9267, J9259 |
| Billing and Coding: Ranibizumab, Aflibercept and Brolucizumab-dbll and Faricimab-svoa Related Terms: eye, ophthalmology, macular |
A52451 | J0178, J0179, J2777, J2778, 67028, 67916, 67917, 67921, 67922, 67923, 67924, C9097, Q5128 |
| Billing and Coding: Removal of Benign Skin Lesions Related Terms: cosmetic |
A54602 | 11200, 11201, 11300, 11301, 11302, 11303, 11305, 11306, 11307, 11308, 11310, 11311, 11312, 11313, 11400, 11401, 11402, 11403, 11404, 11406, 11420, 11421, 11422, 11423, 11424, 11426, 11440, 11441, 11442, 11443, 11444, 11446, 17000, 17003, 17004, 17106, 17107, 17108, 17110, 17111, 17340 |
| Billing and Coding: Single Chamber and Dual Chamber Permanent Cardiac Pacemakers Related Terms: pacemaker |
A54909 | 33206, 33207, 33208 |
| Billing and Coding: Stem Cell Transplantation Related Terms: marrow, BMT, autologous, allogeneic, bone |
A52879 | 38240, 38241 |
| Blepharoplasty - Medical Policy Article Related Terms: eye, cosmetic |
A52837 | 15820, 15821, 15822, 15823, 67900, 67901, 67902, 67903, 67904, 67906, 67908, 67909, 67911, 67914, 67915, 67916, 67917, 67921, 67922, 67923, 67924 |
| Chiropractic Services – Medical Policy Article Related Terms: subluxation, manipulation |
A57889 | 98940, 98941, 98942 |
| Clinical Trials – Medical Policy Article Related Terms: IDE, Q0, modifier |
A52840 | |
| CPT Code 87641 (Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, methicillin resistant, amplified probe technique) - Medical Policy Article Related Terms: staph, MRSA |
A52379 | 87641 |
| Health and Behavior Assessment/Intervention – Medical Policy Article Related Terms: mental, psychologist |
A52434 | 96156, 96158, 96159, 96164, 96165, 96167, 96168, 96170, 96171 |
| Home Health Skilled Nursing Care: Teaching and Training for Dementia Patients with Behavioral Disturbances - Medical Policy Article Related Terms: N/A |
A52845 | G0299, G0300 |
| Investigational Device Exemption Requests - Medical Policy Article Related Terms: IDE, clinical, Q0 modifier |
A52841 | |
| Laparoscopic Sleeve Gastrectomy (LSG) – Medical Policy Article Related Terms: morbid, obesity, weight |
A52447 | 43775 |
| Local Coverage Determination (LCD) Reconsideration Process - Medical Policy Article Related Terms: N/A |
A52842 | |
| New Local Coverage Determination (LCD) Request Process Related Terms: N/A |
A56198 | |
| Off-Label Use of Chemotherapeutic Drugs and Biologicals for Non-Cancer Indications Related Terms: |
A59217 | |
| Off-Label Use of Drugs and Biologicals for Anti-Cancer Chemotherapeutic Regimen Related Terms: |
A59218 | |
| Pegfilgrastim (Fulphila; Neulasta; Neulasta Onpro; Nyvepria; Udenyca; Ziextenzo) Related Terms: |
A59661 | J2506 |
| Polysomnography and Sleep Studies – Medical Policy Article Related Terms: N/A |
A53019 | 95800, 95801, 95805, 95806, 95807, 95808, 95810, 95811, G0398, G0399, G0400 |
| Process for Determining Self-Administered Drug Exclusions – Medical Policy Article Related Terms: SAD |
A53020 | |
| Psychological Services Coverage under the Incident to Provision for Physicians and Nonphysicians – Medical Policy Article Related Terms: psychiatric, mental |
A52825 | 90785, 90832, 90833, 90834, 90836, 90837, 90838, 90846, 90847, 90849, 90853, 90880, 90899 |
| Self-Administered Drug Exclusion List - Medical Policy Article (Jurisdiction 6 Only) Related Terms: SAD |
A53022 | C9399, J0129, J0135, J0270, J0364, J0593, J0599, J0630, J0801, J0802, J1324, J1438, J1559, J1562, J1595, J1628, J1675, J1744, J1815, J1817, J1830, J2170, J2212, J2354, J2440, J2502, J2760, J2940, J2941, J3030, J3031, J3110, J3355, J3490, J3590, J3357, J7999, J9212, J9213, J9216, J9218, Q0515 |
| Self-Administered Drug Exclusion List - Medical Policy Article (Jurisdiction K Only) Related Terms: SAD |
A53021 | C9399, J0129, J0135, J0270, J0364, J0593, J0599, J0630, J0801, J0802, J1324, J1438, J1559, J1562, J1595, J1628, J1675, J1744, J1815, J1817, J1830, J2170, J2212, J2354, J2440, J2502, J2760, J2940, J2941, J3030, J3031, J3110, J3355, J3357, J3490, J3590, J7999, J9212, J9213, J9216, J9218, Q0515 |
| Surveillance of Implantable or Wearable Cardioverter Defibrillators (ICDs): Office, Hospital, Web, or Non-Web Based – Medical Policy Article Related Terms: N/A |
A53018 | 93282, 93283, 93284, 93287, 93289, 93292, 93295, 93296 |