LCD and Article Updates for June/July 2024

Articles

Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms A56867 

Due to the quarterly CPT/HCPCS code update, PLA code 0204U was deleted from CPT/HCPCS Codes section- Group 2, effective for services performed on or after 7/1/2024.

Thyroid Nodule Molecular Testing A58656

PLA code 0473U has 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 7/1/2024.

Billing and Coding: Botulinum Toxins A52848

Added coverage for DAXXIFY™ (daxibotulinumtoxinA-lanm) is manufactured in single-dose vials, with options of 50 Units or 100 Units per vial. When submitting claims for DAXXIFY, it is necessary to use HCPCS code J0589. DAXXIFY can only be billed for cervical dystonia (G24.3). Effective for services rendered on or after 7/1/2024.

Self-Administered Drug Exclusion List: Medical Policy Article A53021 and A53022 

The article has been updated to add a new code for Ustekinumab-auub (Wezlana) (Q5137) effective for dates of service on or after 7/4/2024. The previous miscellaneous codes C9399, J3490, and J3590 have been deleted. A new code for Mirikizumab-mMirikizumab-mrkz (Omvoh™) subcutaneous use* has been added (J2267) effective for dates of service on or after 7/4/2024. The previous miscellaneous codes C9399, J3490, and J3590 have been deleted. The new drug Infliximab-dyyb (Zymfentra) subcutaneous use* has been added to SAD list with the code J1748 effective for dates of service on or after 8/18/2024.

Posted 6/27/2024