LCD, Billing and Coding Article Updates for March 2023

Billing and Coding: Billing and Coding: Implantable Automatic Defibrillators (A56326)

Based on Transmittal 11832 (CR13070) ICD-10-CM and Other Coding Revisions to NCDs - July 2023 Update, HCPCS codes C7537, C7538, C7539 and C7540 have been added effective for dates of service on or after 1/1/2023.

Biomarker Testing for Prostate Cancer Diagnosis (L37733)

Based on the NCCN 1/9/2023 technical correction in NCCN Prostate Cancer Early Detection, Version 1.2023, NGS has corrected the technical error in LCD L37733 accordingly. The NCCN guidelines now include coverage for EPI for men with at least one prior negative biopsy and when a repeat biopsy in patients thought to be at higher risk despite a prior negative biopsy.

Added the following language to the Summary of Evidence:

NCCN Prostate Cancer Early Detection V1.2023-1/9/2023. Accessed 2/6/2023 includes the following corrections of NCCN technical errors:

• PROSD4: “Footnote u modified: Tests that improve specificity in the post-biopsy setting including percent-free PSA, 4Kscore, PHI, PCA3, ConfirmMDx, ExoDx Prostate Test, MPS, and IsoPSA should be considered in patients thought to be higher risk despite a negative prostate biopsy (See PROSD-3).”
• MS-19: “%f PSA, PHI, 4Kscore, EPI, PCA3, and ConfirmMDx may also be considered for those who have had at least one prior negative biopsy and are thought to be at higher risk.”

Posted 2/24/2023