LCD and Article Updates for August/September 2024
Local Coverage Determinations
Facet Joint Interventions for Pain Management L35936
Effective 8/1/2024 - Updated "Coverage Indications, Limitations and/or Medical Necessity" with the following:
B. Therapeutic Facet Joint Procedures (IA or MBB) - removed (IA) under Frequency Limitations.
Limitations #9 - removed, "intraarticular"
Articles
Billing and Coding: Cervical Fusion A59632
Corrected the NCCI Requirements link in the article text.
Added Modifier Table under Coding Guidance in article text
Added the following ICD-10-CM diagnosis codes to the "ICD-10-CM Diagnosis Codes That Support Medical Necessity section-Group1: C41.2, G06.1, M06.88, M40.03, M40.12, M40.202, M40.292, M41.22, M43.12, M43.13, M46.21, M46.22, M46.23, M46.41, M46.42, M46.43, M46.51, M48.31, M48.32, M48.33, M48.42XA, M48.42XD, M48.42XG, M48.43XA, M48.43XG, M48.43XS, M48.51XA, M48.51XG, M48.51XS, M48.52XA, M48.52XG, M48.52XS, M48.53XA, M48.53XG, M50.10, M50.120, M50.20- M50.33, M96.0, M96.1, S12.000A, S12.000B, S12.000D, S12.000G, S12.000K, S12.000S, S12.001A, S12.001B, S12.001D, S12.001G, S12.001K, S12.001S, S12.130A, S12.130B, S12.130D, S12.130G, S12.130K, S12.130S, S12.230A, S12.230B, S12.230D, S12.230G, S12.230K, S12.230S, S12.330A, S12.330B, S12.330D, S12.330G, S12.330K, S12.330S, S12.430A, S12.430B, S12.430D, S12.430G, S12.430K, S12.430S, S12.530A, S12.530B, S12.530D, S12.530G, S12.530K, S12.530S, S12.630A, S12.630B, S12.630D, S12.630G, S12.630K, S12.630S, S12.9XXA, S12.9XXD, S12.9XXS, S13.101A, S13.101D, S13.101S, S13.110A, S13.110D, S13.110S, S13.111A, S13.111D, S13.111S, S13.120A, S13.120D, S13.120S, S13.121A, S13.121D, S13.121S, S13.130A, S13.130D, S13.130S, S13.131A, S13.131D, S13.131S, S13.140A, S13.140D, S13.140S, S13.141A, S13.141D, S13.141S, S13.150A, S13.150D, S13.150S, S13.151A, S13.151D, S13.151S, S13.160A, S13.160D, S13.160S, S13.161A, S13.161D, S13.161S, S13.170A, S13.170D, S13.170S, S13.171A, S13.171D, S13.171S, S13.180A, S13.180D, S13.180S, S13.181A, S13.181D, S13.181S, S13.20XA, S13.20XD, S13.20XS, S13.29XA, S13.29XD and S13.29XS.
Billing and Coding: Hyaluronans Intra-articular Injections of A52420
Clarification was provided in the Article text section under Utilization by replacing the word "Significant" in #2 with the word "Objective".
Billing and Coding: Ranibizumab and biosimilars, Aflibercept, Aflibercept HD, Brolucizumab-dbll and Faricimab-svoa A52451
CPT code J2779 was added to Group 1 CPT/HCPCS Code section. CPT code 67207 was added to Group 3 CPT/HCPCS Code section. The following diagnosis codes were added to the ICD-10-CM Supports Medical Necessity section: H35.3210, H35.3211, H35.3212, H35.3220, H35.3221, H35.3222, H35.3230, H35.3231, H35.3232.
Billing and Coding: Routine Foot Care and Debridement of Nails A57759
Article revised to add ICD-10-CM codes E10.22* and E11.22* to Group 1 in the ICD-10-CM Codes that Support Medical Necessity section.
Billing and Coding: Facet Joint Interventions for Pain Management A57826
Updates below are effective 8/1/2024:
Added verbiage under Coding Guidance.
Added ICD-10-CM codes M53.82, M53.83, M53.84, M53.85, M53.86, and M53.87 to ICD-10-CM Codes that Support Medical Necessity Group 1.
Added Group 1: Medical Necessity ICD-10-CM Codes Asterisk Explanation: To be used for facet cyst.
Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM) A58116
Due to an inadvertent system disruption, the contract numbers omitted in the previous version have been added. There is no change in the original effective date.
Posted 9/6/2024