LCD and Article Updates for March/April 2024
Local Coverage Determinations
Fluid Jet System Treatment for LUTS/BPH (L38367)
The age limitation of >80 years of age has been removed, effective for services rendered on or after 4/1/2024.
Implantable Continuous Glucose Monitors (I-CGM) (L38623)
No changes were made from the proposed LCD that was presented for comment. Effective for services rendered on or after 4/1/2024.
Pain Management – Injection of tendon sheaths, ligaments, ganglion cysts, carpal and tarsal tunnels (L33622)
The LCD has been revised to remove all references to trigger point injections. Please refer to LCD L39662 Trigger Point Injections (TPI). Effective for services rendered on or after 4/1/2024.
Trigger Point Injections (TPI) (L39662)
The new LCD outlines limited coverage for this service with specific details under Coverage Indications, Limitations and/or Medical Necessity.
Billing and Coding Articles
Billing and Coding: Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin and Non-Hodgkin Lymphoma with B-cell or T-cell Origin (A59311)
Based on CR13507 the following ICD-10-PCS codes were added: 30233U2, 30233U3, 30243U2, 30243U3, effective 10/1/2019.
Billing and Coding: Fluid Jet System Treatment for LUTs/BPH (A56797)
The Fluid Jet System treatment for LUTS/BPH is now considered medically reasonable and necessary for patients >80 years of age when the Indications of Coverage have been met in LCD L38367, effective for services rendered on or after 4/1/2024.
Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM) (A58116)
The following ICD-10-CM codes were added: E08.37X1, E08.37X2, E08.37X3, E09.00, E09.01, E09.10, E09.11, E09.21, E09.22, E09.29, E09.311, E09.319, E09.3211, E09.3212, E09.3213, E09.3291, E09.3292, E09.3293, E09.3311, E09.3312, E09.3313, E09.3391, E09.3392, E09.3393, E09.3411, E09.3412, E09.3413, E09.3491, E09.3492, E09.3493, E09.3511, E09.3512, E09.3513, E09.3521, E09.3522, E09.3523, E09.3531, E09.3532, E09.3533, E09.3541, E09.3542, E09.3543, E09.3551, E09.3552, E09.3553, E09.3591, E09.3592, E09.3593, E09.36, E09.37X1, E09.37X2, E09.37X3, E09.39, E09.40, E09.41, E09.42, E09.43, E09.44, E09.49, E09.51, E09.52, E09.59, E09.610, E09.618, E09.620, E09.621, E09.622, E09.628, E09.630, E09.638, E09.641, E09.649, E09.65, E09.69, E09.9, E10.37X1, E10.37X2, E10.37X3, E10.40, E11.37X1, E11.37X2, E11.37X3, E11.9, E13.37X1, E13.37X2, E13.37X3, O24.12, O24.13, O24.811, O24.812, O24.813, O24.82, O24.83 Effective for services rendered on or after 4/1/2024.
Billing and Coding: Pain Management – injection of tendon sheaths, ligaments, ganglion cysts, carpal and tarsal tunnels (A52863)
The article has been revised to remove all references to trigger point injection procedures. Please refer to Article A59847 – Billing and Coding: Trigger Point Injections (TPI). Effective for services rendered on or after 4/1/2024.
Billing and Coding: Trigger Point Injections (TPI) (A59487)
Please refer to the Billing and Coding Article text which includes Coding Guidance, Utilization Parameters, Documentation Requirements, Use of Biologicals and Use of Anesthesia, effective for services rendered on or after 4/1/2024.
Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound (A58893)
Per Transmittal 12501 (CR 13529) – Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) – April 2024 Update, HCPCS code Q4244 has been deleted and Q4310 has been added. Effective for services rendered on or after 4/1/2024.
Billing and Coding: Autonomic Function Testing (A57024)
This article has been updated to include ICD-10 code G90.A to the ICD-10 codes that support medical necessity section, Group 1. Effective for services rendered on or after 10/1/2023.
Billing and Coding: Ranibizumab and biosimilars, Aflibercept, Aflibercept HD, Brolucizumab-dbll and Faricimab-svoa (A52451)
Per Transmittal 12501 (CR 13529) – Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) – April 2024 Update, HCPCS code C9161 has been deleted and replaced with J0177. Effective for services rendered on or after 4/1/2024.
Billing and Coding: Transesophageal Echocardiography (TEE) (A52868)
Added the following ICD-10-CM codes to Group1- ICD-10-CM Codes that Support Medical Necessity section: I26.93, I26.94, effective for services rendered on or after 3/21/2024.
Billing and Coding: Transthoracic Echocardiography (TTE) (A56781)
Added the following ICD-10-CM codes to Group1- ICD-10-CM Codes that Support Medical Necessity section: I26.90, I26.93, I26.94, effective for services rendered on or after 3/21/2024.
Self-Administered Drug Exclusion List: Medical Policy Article (A53021/A53022)
Added a double asterisk to J0801, J0802 and added the following NOTE to the "article text" section of the article: Note: The drugs represented by HCPCS codes J0801 and J0802 (marked with a double asterisk **) are administered by IM or SQ, therefore they require the JB modifier to be reported for SQ administration and they should not have any modifier reported for the IM administration.
Posted 3/25/2024