Local Coverage Determinations and Article Revisions May 2020
The medical policies and related articles can be found in our Medical Policy Center.
Fluid Jet System in the Treatment of Benign Prostatic Hyperplasia (BPH) (L38367)
The Notice period has been extended to 8/31/2020. The Notice period start date has been changed to 4/30/2020. The Revision Effective Date has been changed from 4/1/2020 to 9/1/2020.
Billing and Coding: Bevacizumab and biosimilars (A52370)
Based on compendia review, ICD-10-CM codes G96.8, T66.XXXA, T66.XXXD and T66.XXXS have been added effective for dates of service on or after 05/01/2020. The following has been added to the ICD-10 Codes Asterisk Explanation section: ICD-10-CM code G96.8 must be billed with ICD-10-CM code T66.XXXA, T66.XXXD or T66.XXXS.
Billing and Coding: Bortezomib (A52371)
Based on compendia review, ICD-10-CM codes C46.0, C46.1, C46.2, C46.3, C46.4, C46.51, C46.52, C46.7, C91.00 and C91.02 have been added effective for dates of service on or after 5/1/2020.
Billing and Coding: Filgrastim, Pegfilgrastim, Tbo-filgrastim and biosimilars (A52408)
Based on Transmittal 4543, HCPCS code C9058 has been added to the “CPT/HCPCS Codes Group 1 Paragraph” section and the CPT/HCPCS section of the article to report pegfilgrastim-bmez for Part A services.
Billing and Coding: Infliximab and biosimilars (A52423)
Based on compendia review, ICD-10-CM codes I44.0, I44.1, I44.2, I44.39, I45.0, I45.19, I45.2, I45.3, I45.4, I45.5, I45.6, I45.81 and I45.89 have been added to Group 3 effective for dates of service on or after 5/1/2020.
Billing and Coding: Intravenous Immune Globulin (IVIG) (A52446)
Based on compendia review, ICD-10-CM codes I44.0, I44.1, I44.2, I44.39, I45.0, I45.19, I45.2, I45.3, I45.4, I45.5, I45.6, I45.81 and I45.89 have been added effective for dates of service on or after 5/1/2020.
Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs (A52453)
Based on compendia review, ICD-10-CM codes D25.0, D25.1, D25.2, N60.11, N60.12, N80.0 and N85.01 have been added for HCPCS code J3315 (Group 2), ICD-10-CM code E30.1 has been added for HCPCS code J9202 (Group 4) and ICD-10-CM codes D25.0, D25.1 and D25.2 have been added for HCPCS code J9217 (Group 6) effective for dates of service on or after 5/1/2020.
Billing and Coding: Molecular Pathology Procedures (A56199)
The following wording for CPT code 81445 was corrected:
"please refer to LCD L36376" was revised to read "please refer to LCD L37810".
Billing and Coding: Nivolumab (A54862)
Based on compendia review, ICD-10-CM codes C21.2, C84.Z1-C84.Z9 and C86.0 have been added effective for dates of service on or after 5/1/2020. The last sentence in the “Utilization Guidelines” has been changed to: If the PD-1 directed agent was discontinued for reasons other than disease progression, then nivolumab may be used when an approved indication is met.
Posted 4/27/2020