LCD and Article Updates for August 2024

Articles

L33394/A52423 – Drugs and Biologicals
Provided off-label coverage of Infliximab for microscopic colitis and retirement of Bortezomib article, effective 8/1/2024. The article has been revised to add *K52.89 to indicate microscopic colitis, Group 3 - "ICD-10 Codes that support medical necessity" section.

L35000/A56199 – Molecular Policy Procedures
Ceramides testing (PLA Code 0019U) to risk stratify patients at risk of future atherosclerotic events is considered not reasonable and necessary; therefore, is not covered, effective 8/1/2024.

L35936/A57826 – FACET Joint Injections for Pain Management
Clarified the non-coverage of 3rd level injection language and supporting evidence on the use of anesthesia in conjunction with facet injections and RFA. Addressed the reconsideration of therapeutic joint injection as a first line option, effective 8/1/2024.

L39726/A59595 – KidneyIntelX and KidneyIntelX.dkd Testing
Coverage provided for once in a lifetime testing to identify risk level for Chronic Kidney Disease, effective 8/1/2024.

L39770/A59632 – Cervical Fusion    
Cervical Fusion is considered medically reasonable and necessary for the decompression of symptomatic nerve root impingement when the criteria, listed in the Indications of Coverage are met, effective 8/1/2024.

Posted 7/29/2024