LCD and Article Revisions: January–February 2020

The medical policies and related articles can be found in our Medical Policy Center

LCD Revisions

Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF) (L33569)

This clarification has been added to the Indications section of the LCD:

Provisions in this LCD and related coding article only address Vertebral Augmentation for Osteoporotic Vertebral Compression Fracture (VCF). Coverage will remain available for medically necessary procedures for other conditions not included in this LCD.

Article Revisions

Billing and Coding: Cardiac Catheterization and Coronary Angiography (A52850)

The article has been revised to add ICD-10 codes I42.0-I42.9 to Group 3 covered diagnoses, effective for dates of service from 10/1/2019.

Billing and Coding: Intravenous Immune Globulin (IVIG) (A52446)

The article has been revised to add documentation requirements that were inadvertently removed with the last update.

Billing and Coding: Micro-Invasive Glaucoma Surgery (MIGS) (A56588)

Added the following specific, coding guideline to the Article Text section to clarify the billing of CPT code 0376T, effective for services rendered on or after 12/01/2019:

"iStent inject is a 2-stent device, and therefore, is adequately described by 0191T. Billing of 0376T (an additional device) in addition to 0191T is inappropriate."

Billing and Coding: Outpatient Physical and Occupational Therapy Services (A56566)

Article corrected to add CPT codes 97545 and 97546 which were inadvertently omitted from the previous revision and to remove CPT code 95933 which was added to the CPT code list in error.

Billing and Coding: Pain Management (A52863)

CPT code 64451 has been added to the bilateral surgery guidelines under the “Sacroiliac (SI) Joint Injections” section.

The following sentence has been added to the paragraph for CPT code 64625 in the “Indications” section of the article:

Radiofrequency ablation for denervation whether performed using traditional, cooled, or pulsed radiofrequency is considered investigational and therefore, not medically necessary.

“Non-Covered Service” has been added to the Group 4 paragraph section.

Polysomnography and Sleep Studies – Medical Policy Article (A53019)

The first paragraph under the Indications and Limitations has been revised to state:

For all hospital based facilities, the facility must be under the direction and control of physicians that are board certified or eligible in sleep medicine. All non-hospital based facilities must be certified by the American Academy of Sleep Medicine, The Joint Commission, or the Accreditation Commission for Health Care, Inc.

Posted 1/24/2020