LCD and Billing and Coding Article Updates January/February 2024
Billing and Coding: Off-Label Use of Intravenous Immune Globulin (IVIG) (A59105)
A list of labeled and compendia approved diagnoses have been added to the Group 2 section for ICD-10-CM Codes that Support Medical Necessity, based on provider request.
Billing and Coding: Off-label Use of Rituximab and Rituximab Biosimilars (A59101)
A list of labeled and compendia approved diagnoses have been added to the Group 2 section for ICD-10-CM Codes that Support Medical Necessity, based on provider request.
Self-Administered Drug Exclusion List: Medical Policy Article (A50321/A53022)
The article has been updated to add Ustekinumab-auub (Wezlana™) (C9399, J3490, J3590) effective for dates of service on or after 3/16/2024.
Psychiatry and Psychology Services (L33632)
Consistent with Change Request 13167, the following sections have been revised: Approved Providers of Service, General Coverage Requirements, Coverage Criteria and Specific Coverage Requirements. There has been no change in coverage with this LCD revision.
Billing and Coding: Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms (A56867)
PLA codes 0326U and 0334U have been added to the CPT/HCPCS Codes section, and to the Group 3- Paragraph in the ICD-10-CM Codes that Support Medical Necessity section, effective for services rendered on or after 2/1/2024.
Billing and Coding: Psychiatry and Psychology Services (A56937)
Consistent with Change Request 13167, the following sections have been revised: Specific Coding Guidelines and Documentation Requirements to include the statement “unless otherwise indicated, providers of mental health services licensed or otherwise authorized as designated by Medicare and the state in which they practice.”
Psychological Services Coverage under the Incident to Provision for Physicians and Non-physicians – Medical Policy Article (A52825)
Consistent with Change Request 13167, the following sections have been revised: Indications and Limitations, to include marriage and family therapists and mental health counselors.
Health and Behavior Assessment/Intervention – Medical Policy Article (A52434)
Due to CR 13469, the article text was updated to add "Health Behavior Assessment and Intervention (HBAI) services described by CPT codes 96156, 96158, 96159, 96164, 96165, 96167, and 96168 and any successor codes, are billed by clinical social workers, marriage and family therapists (MFTs) and mental health counselors (MHCs), in addition to clinical psychologists." Coding references have been updated.
New Article Effective 2/1/2024:
Pegfilgrastim (Fulphila; Neulasta; Neulasta Onpro; Nyvepria; Udenyca; Ziextenzo) J2506 (A59661)
Pegfilgrastim is recommended to be given according to FDA approved dosing schedule. NGS will consider same day administration when patient/caregiver circumstances create a significant barrier to compliance, such as lack of transportation to return for dosing within recommended time frame. National Government Services expects clear documentation for same day administration to be in the medical record and available upon request, effective for services rendered on or after 2/1/2024.
Posted 1/24/2024