LCD and Article Revisions for August 2020
The medical policies and related articles can be found in our Medical Policy Center.
Billing and Coding: Bevacizumab and biosimilars (A52370)
Based on compendia review, ICD-10-CM codes C22.0, C22.8 and C22.9 have been added effective for dates of service on or after 8/1/2020.
Billing and Coding: Filgrastim, Pegfilgrastim, Tbo-filgrastim and biosimilars (A52408)
Based on Transmittal 10196 (CR 11792 - Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes - July 2020 Update), - C9058 has been deleted and replaced with HCPCS code Q5120 to report pegfilgrastim-bmez. Outdated information has been removed.
Billing and Coding: Hyaluronans Intra-articular Injections of (A52420)
Based on Transmittal 10165 (CR 11792 - July 2020 Integrated Outpatient Code Editor (I/OCE) Specifications Version 21.2), the article has been updated to add HCPCS code J7333 for Visco-3™. The terminology for HCPCS code J7321 has been revised.
Billing and Coding: Infliximab and biosimilars (A52423)
Based on Transmittal 10120 (CR 11788 - Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - July 2020 Update), HCPCS code Q5121 has been added to report infliximab-axxq effective for dates of service on or after 7/1/2020. Coding guidelines 1 and 2 have been revised to include “biosimilars”. Coding guideline 2 has been revised to add JW modifier language. Coding guidelines 3 and 4 have been deleted.
Billing and Coding: Intravenous Immune Globulin (IVIG) (A52446)
ICD-10-CM code M30.3 has been added effective for dates of service on or after 10/1/2015.
Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™) (A52450)
Based on compendia review, ICD-10-CM code Z85.49 has been added to Group 2 for paclitaxel effective for dates of service on or after 8/1/2020.
Billing and Coding: Rituximab, biosimilars and Rituximab and hyaluronidase human (Rituxan Hycela™) (A52452)
Based on Transmittal 10196 (CR 11769 - Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes - July 2020 Update), HCPCS code Q5119 has been added to the article to report rituximab-pvvr effective for dates of service on or after 2/3/2020.
Pain Management (L33622)
Based on Transmittal 10128, (CR 11755 - National Coverage Determination (NCD 30.3.3): Acupuncture for Chronic Low Back Pain (cLBP), the LCD has been revised to add: Effective 1/21/2020, Medicare will cover all types of acupuncture including dry needling for chronic low back pain within specific guidelines in accordance with NCD 30.3.3.
Billing and Coding: Pain Management (A52863)
Based on Transmittal 10128, (CR 11755 - National Coverage Determination (NCD 30.3.3): Acupuncture for Chronic Low Back Pain (cLBP), the article has been revised to add: Effective 1/21/2020, Medicare will cover all types of acupuncture including dry needling for chronic low back pain within specific guidelines in accordance with NCD 30.3.3. CPT codes 64625 and 64999 have been moved to Group 5 in the CPT/HCPC Code Group section.
Prostate Rectal Spacers (L37485)
Added coverage associated with moderate hypofractionated RTX, effective for services rendered on or after 8/1/2020.
Posted 7/23/2020