LCD, Billing and Coding Article Updates for March and April 2023

Pain Management (L33622)

Effective 3/19/2023

The LCD has been revised to remove all references to sacroiliac joint injections. Please refer to LCD L39455 Sacroiliac Joint Injections and Procedures.

Billing and Coding: Pain Management (A52863)

The article has been revised to remove all references to sacroiliac joint injection procedures. Please refer to Article A59233 - Billing and Coding: Sacroiliac Joint Injections and Procedures.

Sacroiliac Joint Injections and Procedures (L39455)

This is a new collaborative LCD. The sacroiliac joint injection information was previously in the Pain Management LCD (L33622). The Indications and Limitations have been expanded upon and frequency guidelines have been added in this new LCD. There are also changes in the payable diagnoses.

Billing and Coding: Sacroiliac Joint Injections and Procedures (A59233)

This is a new collaborative Billing and Coding article.

Billing and Coding: Incision and Drainage (I&D) of Abscess of Skin, Subcutaneous and Accessory Structures (A56766)

Effective 4/1/2023

This article has been updated to add the following ICD-10 codes: L05.91 and L05.92.

Non-Invasive Fractional Flow Reserve (FFR) for Ischemic Heart Disease (L39075)

The LCD has been updated to reflect new literature and changes in guidelines from the 2021 AHA /ACC/ASE/CHEST/SAEM/ SCCT/SCMR

• Guidelines for use of FFRct with a moderate strength recommendation expanded the role of FFRct in specific clinical settings as an alternative to stress test.1
• The intermediate stenosis range on CCTA has been expanded to 40-90%, vessel specific limits revised, and expansion to stable chest pain has been added to align with the clinical scenarios specified in the guidelines.
• A new requirement has been added that the FFRct will not be covered in conjunction with stress testing unless CCTA was not sufficient quality for FFRct, and an alternative study is needed.
• The severe obesity is removed as a limitation based on publication of new literature to support its use in patients with BMI >39 if the scanner used for CCTA can enable high quality images in setting of severe obesity.
• The limitation on aortic stenosis was removed based on new literature demonstrating accuracy in this population.

Billing and Coding: Non-Invasive Fractional Flow Reserve (FFR) for Ischemic Heart Disease (A58814)

The LCD and article were taken for comment in October 2022. No changes have been made in the article.

Transcranial Magnetic Stimulation (L33398)

Based on a reconsideration request received March 2021, the “Summary of Evidence” and the “Analysis of Evidence" sections were revised and sources were added to the bibliography. The Indications and Limitations in the "Coverage Indications, Limitations and/or Medical Necessity" section have also been revised.

Billing and Coding: Bevacizumab and biosimilars (A52370)

Based on Transmittal 11848 (CR 13092) - Quarterly Update to the MPFSDB - April 2023 Update, HCPCS code Q5129 has been added for Bevacizumab-adcd (Vegzelma®). Based on compendia review, ICD-10 codes D19.1 and Z85.41 have been added to the Group 1 ICD-10 code list effective 04/01/2023.

Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™) (A52450)

Based on compendia review, ICD-10 codes C53.0, C53.1 and C53.8 have been added to the Group 1 ICD-10 code list for albumin-bound paclitaxel and ICD-10 code D38.4 has been added to the Group 2 ICD-10 code list for paclitaxel effective for dates of service on or after 04/01/2023.

Billing and Coding: Ranibizumab and biosimilars, Aflibercept, Brolucizumab-dbll and Faricimab-svoa (A52451)

Based on Transmittal 11848 (CR 13092) - Quarterly Update to the MPFSDB - April 2023 Update, HCPCS code Q5128 has been added for Ranibizumab-eqrn (CIMERLI™).

Water Vapor Thermal Therapy for LUTS /BPH (L37808)

Based on a reconsideration request to provide coverage for prostate size >80 grams (120 grams), the “Summary of Evidence” and “Analysis of Evidence” sections have been revised and sources have been added to the “Bibliography” section of the LCD. No changes were made in coverage.

Posted 3/29/2023