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National Government Services Local Coverage Determinations
Welcome to Medical Policies. Below you will find the LCDs, related billing & coding articles and additional medical policy topics. When entering criteria into the search box, the search results will be conducted within the LCDs and the Medical Policy Articles shown below.
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.
For additional Medical Policy Topics, refer to the bottom of the page.[View Draft Policies | View Future Effective LCDs | View Future Effective Billing & Coding Articles | National Coverage Determinations |
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 |
| Artificial Intelligence Enabled CT Based Quantitative Coronary Topography (AI-QCT)/Coronary Plaque Analysis (AI-CPA) Related terms: N/A |
L39863 | A59733 | A59929 | 0623T, 0624T, 0625T, 0626T |
| 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 | A59913 | 76376, 76377, 93312, 93313, 93314, 93315, 93316, 93317, 93318, 93319, 93320, 93321, 93325, 93355, 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 |