LCD and Article Updates for April and May 2021
April 2021 Medical Policy Article Updates
Billing and Coding: Breast Imaging: Breast Echography (Sonography)/Breast MRI/Ductography (A52849)
This article has been updated due to a provider request to add the following diagnosis codes to Group 1 in the “ICD-10 codes that support medical necessity” section: Z86.000, Z86.018, Z86.03 and Z87.42.
May 2021 New Medical Policy Article
Billing and Coding: Complex Drug Administration Coding (A58620)
All MAC collaborative article on correct billing of drug administration codes.
May 2021 LCD and Medical Policy Article Updates
Botulinum Toxins (L33646)
Based on an FDA label update, the indication for “Urinary Incontinence” has been updated to add “and patients five years of age and older” to the following paragraph:
OnabotulinumtoxinA is indicated for the treatment of OAB with symptoms of urge urinary incontinence, urgency and frequency, in adults and patients five years of age and older who have an inadequate response to or are intolerant of an anticholinergic medication.
Billing and Coding: Bevacizumab and Biosimilars (A52370)
Based on compendia review, ICD-10 codes C17.3 and C24.1 have been added to the Group 1 ICD-10 code list effective for dates of service on or after 5/1/2021.
Billing and Coding: Bortezomib (A52371)
Based on compendia review, ICD-10 codes B10.89 and D47.2 have been added effective for dates of service on or after 5/1/2021.
Billing and Coding: Drugs and Biologicals (A52855)
The Drug Administration Services and Unlisted Code information has been removed from this article and has been added to Billing and Coding: Complex Drug Administration Coding article A58620.
Billing and Coding: Filgrastim, Pegfilgrastim, Tbo-filgrastim and biosimilars (A52408)
Based on compendia review, ICD-10 codes C64.1 and C64.2 have been added to the Group 1 and Group 4 ICD-10 code lists for pegfilgrastim and biosimilars and filgrastim and biosimilars effective for dates of service on or after 5/1/2021.
Billing and Coding: Hyaluronans Intra-articular Injections of (A52420)
Based on Transmittal 10631 (CR 12155) ‒ Quarterly Update to the MPFSDB – April 2021 Update, HCPCS code J7333 is being deleted effective for dates of service on or after 4/1/2021. The description for HCPCS code J7321 has been revised to include “Visco-3.”
Billing and Coding: Infliximab and biosimilars (A52423)
Based on compendia review, ICD-10 code I47.2 has been added to the Group 3 list effective for dates of service on or after 5/1/2021.
Billing and Coding: Intravenous Immune Globulin (IVIG) (A52446)
Based on Transmittal 10666 (CR 12175) – April 2021 Update of the Hospital OPPS, HCPCS code C9072 has been deleted and is being replaced with code J1554 effective for dates of service on or after 4/1/2021. Based on compendia review, ICD-10 codes G57.81, G57.82, G57.83, G61.1, I40.8 and I47.2 have been added effective for dates of service on or after 5/1/2021.
Molecular Pathology Procedures (A56199)
Added CPT code 81353, which had been inadvertently omitted to CPT/HCPCS Code section-Group 2, effective 1/1/2021.
Deleted SCA1 CPT code 81479from the CPT/HCPCS code section- Group 4 Paragraph, Tier 2/NOC Noncovered Code/Gene Combinations, due to the inadvertent inclusion of SCA1 as a gene in error.
Added PLA code 0070U to the ICD-10-CM Diagnosis Codes That Support Medical Necessity and to the Paragraph, Group 9, effective 5/15/2021.
Added PLA code 0070U to CPT/HCPCS Code Section- Group 1, effective 5/15/2021.
Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™) (A52450)
Based on compendia review, ICD-10 codes C23 and C24.1 have been added to the Group 1 list for albumin-bound paclitaxel and ICD-10 code C24.1 has been added to the Group 2 list for paclitaxel effective for dates of service on or after 5/1/2021.
Billing and Coding: Rituximab, biosimilars and Rituximab and hyaluronidase human (Rituxan Hycela™) (A52452)
Based on compendia review, ICD-10 codes D76.3 and D89.812 have been added to the Group 1 list for rituximab and biosimilars and ICD-10 code B10.89 has been added to the Group 2 list for rituximab and hyaluronidase human effective for dates of service on or after 5/1/2021.
Posted 4/26/2021