Local Coverage Determination and Article Revisions: June–July 2019
All medical policies and related articles can be found on the NGS Medical Policy Center.
LCD Revisions for June 2019
Psychiatric Partial Hospitalization Programs (L33626)
LCD updated to reinstate CPT codes 90849 and 90853 billable by Part B Providers.
LCD Revisions for July 2019
Corneal Pachymetry (L33630)
Added the following ICD-10-CM diagnosis codes to the "ICD-10 Codes that Support Medical Necessity" section: H18.221, H18.222, H18.223, H18.231, H18, 232, H18.233 and deleted diagnosis code H18.20, effective for services rendered on or after 6/15/2019.
Frequency of Hemodialysis (L37475)
LCD revised and published 7/4/2019 effective for dates of service on and after 7/1/2019 consistent with Change Request 10901 to remove language from CMS IOMs and/or regulations, list applicable manual/regulation reference and to remove all CPT and ICD-10 diagnosis codes. IOM references have been updated and all codes have been placed in the companion Local Coverage Article A55672 Billing and Coding: Frequency of Hemodialysis. There will not be a lapse in coverage and there has been no change to the coverage content of this LCD.
Outpatient Physical and Occupational Therapy Services (L33631)
LCD revised effective 7/1/2019 to add CPT code 0552T (Low-level laser therapy, dynamic photonic and dynamic thermokinetic energies, provided by a physician or other qualified health care professional) as noncovered, to the CPTHCPCS section, and elsewhere where the service is listed in the LCD.
Psychiatry and Psychology Services (L33632)
LCD was revised to clarify that severe and profound intellectual disabilities are never covered for psychotherapy services or psychoanalysis. The following ICD-10-CM codes were removed from Psychiatric Diagnoses Group 1 and added to ICD-10 Codes that do not Support Medical Necessity Group 1: F72, F73 and F79.
A typographical error was corrected in Coverage Indications, Limitations and/or Medical Necessity.
Article Revisions
Billing and Coding: Category III CPT® Codes (A56195)
Effective for services rendered on or after 7/1/2019, 0543T- 0551T and 0553T-0562T were added to Group 3 (CPT codes that will be individually reviewed to determine medical necessity). CPT code 0508T was deleted and added to the NCD for Bone (Mineral) Density Studies (150.3).
Billing and Coding: Frequency of Hemodialysis (A55672)
Article revised and published on 7/4/2019 effective for dates of service on and after 7/1/2019. Consistent with CMS CR10901, the CPT and ICD-10 codes have been removed from the related LCD and added to the article. In response to an inquiry, language in Article Text item #1 has been modified for clarification regarding the hemodialysis prescription.
Ranibizumab (e.g., Lucentis™) and Aflibercept (e.g., Eylea™) – Related to LCD L33394 (A52451)
The indication for aflibercept for diabetic retinopathy (DR) in patients with DME has been revised to diabetic retinopathy (DR) based on FDA approval effective 5/13/2019. The following ICD-10-CM codes have been added for aflibercept:
E08.319, E08.3291, E08.3292, E08.3293, E08.3391, E08.3392, E08.3393, E08.3491, E08.3492, E08.3493, E09.319, E09.3291, E09.3292, E09.3293, E09.3391, E09.3392, E09.3393, E09.3491, E09.3492, E09.3493, E10.319, E10.3291, E10.3292, E10.3293, E10.3391, E10.3392, E10.3393, E10.3491, E10.3492, E10.3493, E11.319, E11.3291, E11.3292, E11.3293, E11.3391, E11.3392, E11.3393, E11.3491, E11.3492, E11.3493, E13.319, E13.3291, E13.3292, E13.3293, E13.3391, E13.3392, E13.3393, E13.3491, E13.3492 and E13.3493 effective for dates of service on or after 5/13/2019.
Rituximab (Rituxan®), Rituximab and hyaluronidase human (Rituxan Hycela™) and Rituximab-abbs (Truxima®) - Related to LCD L33394 (A52452)
Based on Transmittal 4306 - Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes, HCPCS code Q5115 ‒ Injection, rituximab-abbs, biosimilar, 10 mg has been added to the “CPT/HCPC Codes” paragraph section of the article. Rituximab-abbs has been added throughout the article.
The following indications have been added for rituximab and rituximab-abbs:
- Rheumatoid arthritis, in combination with methotrexate in patients with an inadequate response to methotrexate
- Burkitt’s lymphomas, in combination with chemotherapy
- Hairy cell leukemia
- Mantle cell lymphoma ‒ maintenance, following first-line induction therapy and untreated, induction therapy, in combination with anthracycline-based regimens
- Primary cutaneous lymphomas
Stem Cell Transplantation – Medical Policy Article (A52879)
Based on Transmittal 2243, CR11134 ‒ International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to NCDs: ICD-10-CM code D47.1 has been added to the Group 1 code list for CPT code 38240 effective 7/1/2019. ICD-10-CM code D47.1 is payable for allogeneic SCT in a Clinical Trial (38240) for Myelofibrosis. Outdated information has been removed.
Future Effective LCD
Corneal Hysteresis (L38014)
This is a noncoverage policy for all corneal hysteresis assessments as a means of risk assessment or monitoring for progression of ophthalmic disease activity, effective for services rendered on or after 8/1/2019.
Posted 6/26/2019