Local Coverage Determination and Article Revisions November–December 2019

LCDs and Articles Revised in November and December:

B-type Natriuretic Peptide (BNP) Testing (L33573)

Consistent with Change Request 10901, all coding information, National coverage provisions, and Associated Information (Documentation Requirements, Utilization Guidelines) were removed from the LCD and placed in the related Billing and Coding Article, A56826. There was no change in coverage with this LCD revision.

Botulinum Toxins (L33646)

The LCD has been revised to add the following indications which were inadvertently removed with the last update:

OnabotulinumtoxinA is indicated for the treatment of lower limb spasticity in adult patients to decrease the severity of increased muscle tone in ankle and toe flexors (gastrocnemius, soleus, tibialis posterior, flexor hallucis longus, and flexor digitorum longus).

AbobotulinumtoxinA is indicated for the treatment of lower limb spasticity in adults.

OnabotulinumtoxinA is indicated for the treatment of overactive bladder (OAB) with symptoms of urge urinary incontinence, urgency, and frequency, in adults who have an inadequate response to or are intolerant of an anticholinergic medication.

Drugs and Biologicals, Coverage of, for Label and Off-Label Uses (L33394)

Consistent with Change Request 10901, all coding information, National coverage provisions, and Associated Information (Documentation Requirements, Utilization Guidelines) have been removed from the LCD and placed in the related Billing and Coding Article, A52855. There has been no change in coverage with this LCD revision.

Heavy Metal Testing (L35074)

Consistent with Change Request 10901, all coding information, National coverage provisions, and Associated Information (Documentation Requirements, Utilization Guidelines) were removed from the LCD and placed in the related Billing and Coding Article, A56767. There was no change in coverage with this LCD revision.

Hospice - Determining Terminal Status (L33393)

Consistent with Change Request 10901, all coding information, National coverage provisions, and Associated Information (Documentation Requirements, Utilization Guidelines) were from the LCD and placed in the related Billing and Coding Article, A52830. There was no change in coverage with this LCD revision.

Nerve Conduction Studies and Electromyography (L35098)

Consistent with Change Request 10901, all coding information, National coverage provisions, and Associated Information (Documentation Requirements, Utilization Guidelines) have been removed from the LCD and placed in the related Billing and Coding Article, A57668. There has been no change in coverage with this LCD revision.

Non-covered Services (L33629)

Consistent with Change Request 10901, all coding information, National coverage provisions, and Associated Information (Documentation Requirements, Utilization Guidelines) have been removed from the LCD and placed in the related Billing and Coding Article, A57812. There has been no change in coverage with this LCD revision.

Percutaneous Coronary Intervention (L33623)

Consistent with Change Request 10901, all coding information, National coverage provisions, and Associated Information (Documentation Requirements, Utilization Guidelines) were removed from the LCD and placed in the related Billing and Coding Article, A56823. There was no change in coverage with this LCD revision.

Peripheral Nerve Blocks (L36850)

Consistent with Change Request 10901, all coding information, National coverage provisions, and Associated Information (Documentation Requirements, Utilization Guidelines) have been removed from the LCD and placed in the related Billing and Coding Article, A57452. There has been no change in coverage with this LCD revision.

Proton Beam Therapy (L35075)

Consistent with Change Request 10901, all coding information, National coverage provisions, and Associated Information (Documentation Requirements, Utilization Guidelines) were removed from the LCD and placed in the related Billing and Coding Article, A56827. There was no change in coverage with this LCD revision.

Psychiatric Inpatient Hospitalization (L33624)

Consistent with Change Request 10901, all coding information, National coverage provisions, and Associated Information (Documentation Requirements, Utilization Guidelines) were removed from the LCD and placed in the related Billing and Coding Article, A56865. There was no change in coverage with this LCD revision.

Psychiatric Partial Hospitalization Programs (L33626)

Consistent with Change Request 10901, all coding information, National coverage provisions, and Associated Information (Documentation Requirements, Utilization Guidelines) were removed from the LCD and placed in the related Billing and Coding Article, A56850. There was no change in coverage with this LCD revision.

Psychiatry and Psychology Services (L33632) Effective: 07/01/2019

LCD was revised to include Documentation Requirements which were inadvertently omitted in a previous version.

Psychiatry and Psychology Services (L33632)

Consistent with Change Request 10901, all coding information, National coverage provisions, and Associated Information (Documentation Requirements, Utilization Guidelines) were removed from the LCD and placed in the related Billing and Coding Article, A56937. There was no change in coverage with this LCD revision.

Venous Angioplasty with or without Stent Placement for the Treatment of Chronic Cerebrospinal Venous Insufficiency (L35028)

Consistent with Change Request 10901, all coding information, National coverage provisions, and Associated Information (Documentation Requirements, Utilization Guidelines) were removed from the LCD and placed in the related Billing and Coding Article, A56845. There was no change in coverage with this LCD revision.

Vitamin D Assay Testing (L37535)

Consistent with Change Request 10901, all coding information, National coverage provisions, and Associated Information (Documentation Requirements, Utilization Guidelines) have been removed from the LCD and placed in the related Billing and Coding Article, A57736. There has been no change in coverage with this LCD revision.

LCDs effective 12/1/2019

Biomarker Testing (Prior to Initial Biopsy) for Prostate Cancer Diagnosis (L37733)

Consistent with Change Request 10901, all coding information, National coverage provisions, and Associated Information (Documentation Requirements, Utilization Guidelines) have been removed from the LCD and placed in the related Billing and Coding Article, A56609.

Based on a reconsideration request, coverage for EPI (0005U) was added for patients with moderately elevated PSA levels.

Micro-Invasive Glaucoma Surgery (MIGS) (L37244)

Consistent with Change Request 10901, all coding information, National coverage provisions, and Associated Information (Documentation Requirements, Utilization Guidelines) have been removed from the LCD and placed in the related Billing and Coding Article, A56588.

Based on a reconsideration request, added coverage for iStent inject.

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

The LCD has been revised to address Percutaneous Vertebral Augmentation (PVA) only for Osteoporotic Vertebral Compression Fracture (VCF). Specific inclusion and exclusion criteria have been added to Indications and Limitation of Coverage.

Consistent with Change Request 10901, all coding information, National coverage provisions, and Associated Information (Documentation Requirements, Utilization Guidelines) have been removed from the LCD and placed in the related Billing and coding Article, A56178.

Water Vapor Thermal Therapy for LUTS/BPH (L37808)

Consistent with Change Request 10901, all coding information, National coverage provisions, and Associated Information (Documentation Requirements, Utilization Guidelines) have been removed from the LCD and placed in the related Billing and coding Article, A56590.

Based on a reconsideration request, the obstructing median lobe requirement was removed from the LCD.

LCDs/Articles Converted to New Format

The following LCDs were converted to the new “no-codes” format. There has been no change in coverage with these revisions:

• Osteopathic Manipulative Treatment (L33616)
• Treatment of Varicose Veins of the Lower Extremity (L33575)

These articles were revised to convert to the new coding format, and to remove Bill Types and Revenue Codes:

• Billing and Coding: Botulinum Toxins (A52848)
• Billing and Coding: Bevacizumab and biosimilars (A52370)
• Billing and Coding: Bortezomib (A52371)
• Billing and Coding: Denosumab (Prolia ™, Xgeva ™) (A52399)
• Billing and Coding: Drugs and Biologicals (A52855)
• Billing and Coding: Eculizumab (A54548)
• Billing and Coding: Filgrastim, Pegfilgrastim, Tbo-filgrastim and biosimilars (A52408)
• Billing and Coding: Hyaluronans Intra-articular Injections of (A52420)
• Billing and Coding: Ibandronate Sodium (A52421)
• Billing and Coding: Infliximab and biosimilars (A52423)
• Billing and Coding: Intravenous Immune Globulin (IVIG) (A52446)
• Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs (A52453)
• Billing and Coding: Nivolumab (A54862)
• Billing and Coding: Omalizumab (A52448)
• Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™) (A52450)
• Billing and Coding: Ranibizumab and Aflibercept (A52451)
• Billing and Coding: Rituximab, Rituximab-abbs and Rituximab and hyaluronidase human (Rituxan Hycela™) (A52452)
• Billing and Coding: Treatment of Varicose Veins of the Lower Extremity (A52870)

New Billing and Coding Articles

• Billing and Coding: B-type Natriuretic Peptide (BNP) Testing (A56826)
• Billing and Coding: Heavy Metal Testing (A56767)
• Billing and Coding: Hospice - Determining Terminal Status (A52830)
• Billing and Coding: Nerve Conduction Studies and Electromyography (A57668)
• Billing and Coding: Osteopathic Manipulative Treatment (A56954)
• Billing and Coding: Percutaneous Coronary Intervention (A56823)
• Billing and Coding: Peripheral Nerve Blocks (A57452)
• Billing and Coding: Proton Beam Therapy (A56827)
• Billing and Coding: Psychiatric Inpatient Hospitalization (A56865)
• Billing and Coding: Psychiatric Partial Hospitalization Programs (A56850)
• Billing and Coding: Psychiatry and Psychology Services (A56937)
• Billing and Coding: RAST Type Tests (A56844)
• Billing and Coding: Reduction Mammaplasty (A56837)
• Billing and Coding: Venous Angioplasty with or without Stent Placement for the Treatment of Chronic Cerebrospinal Venous Insufficiency (A56845)
• Billing and Coding: Non-covered Services (57812)
• Billing and Coding: Vitamin D Assay Testing (A57736)

Posted 11/25/2019