LCD and Article Updates for December 2020 and January 2021*
Revised Billing and Coding Articles December 2020 and January 2021
Billing and Coding: Bevacizumab and biosimilars (A52370)
Based on compendia review, ICD-10 code C22.3 has been added to Group 1 ICD-10 code list effective for dates of service on or after 1/1/2021.
Billing and Coding: Colorectal Cancer Screening – Medical Policy Article (A52378)
Based on CMS Transmittal 2427, the article was revised effective for dates of service on or after 10/1/2019, to add ICD-10 code Z86.004, and delete ICD-10 codes C18.9 and D12.6 from the Group 2 list of payable diagnoses. Bill type and Revenue codes were removed from the article. Guidance on these codes is available in the Bill type and Revenue code sections.
Billing and Coding: Filgrastim, Pegfilgrastim, Tbo-filgrastim and biosimilars(A52408)
Based on the annual HCPCS update, HCPCS code Q5122 has been added to the "CPT/HCPCS Codes Paragraph" section of the article.
Billing and Coding: Intravenous Immune Globulin (IVIG)(A52446)
Based on compendia review, ICD-10 codes I47.0, L51.1, L51.2 and M06.4 have been added to the ICD-10 code list effective for dates of service on or after 1/1/2021. Based on the annual HCPCS update, HCPCS code C9072 has been added to the “CPT/HCPCS Paragraph” section of the article.
Billing and Coding: Molecular Pathology Procedures (A56199)
The Indications of Coverage by CPT code section was revised as follows:
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- CPT Code 81401 was replaced by CPT codes (81168) CCND1/IGH ;(81278) (BCL1/IgH, t)
- CPT Code 81402 was replaced by CPT code (81338) MPL
- CPT Code 81403 was replaced by CPT code 81339) MPL
- CPT Code 81403 was replaced by CPT code (81279) JAK2
- CPT code 81404 was replaced by CPT code (81352) TP53, and CPT code 81405 was replaced by CPT code (81351) TP53
- CPT code 81479 was replaced by CPT code (81347) RARS
The CPT/HCPCS Codes Section was revised as follows:
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- Group 1 Tier 1 Covered Codes: Added CPT codes 81168, 81338, 81339, 81347, 81348, 81351, 81352.
- Group 2 Tier 1 Individual Review Codes: Added CPT codes 81191, 81192, 81193, 81194, 81353, 81357, 81419, 81529, 81546, 81554, 81360.
- Group 4 Tier 2 CPT and NOC Codes: CPT code 81401 CND1/IGH was replaced by 81168-now in Group 1; CPT code 81405 TP53 was replaced by 81353- now in Group 2 ; CPT code 81479 RARS was replaced by 81347- now in Group 1.
ICD-10 Codes that Support Medical Necessity Section was revised as follows
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- Group 14: Paragraph: CPT codes Deleted code 81402 MPL was replaced by 81338; 81403 MPL was replaced by 81339, and 81403 JAK2 was replaced by 81279.
- Group 23: Paragraph: CPT code 81401 CCND1/IGH was replaced by 81168.
- Group 29: Paragraph: CPT codes 81404 TP53 was replaced by 81352; CPT code 81405 TP53 was replaced by
Billing and Coding: Nivolumab (A54862)
Based on compendia review, ICD-10 codes C51.0-C51.2, C51.8, C54.0-C54.3, C54.8 and C84.91-C84.99 have been added to the ICD-10 code list effective for dates of service on or after 1/1/2021.
Billing and Coding: Rituximab, biosimilars and Rituximab and hyaluronidase human (Rituxan Hycela™) (A52452)
Based on compendia review, ICD-10 code C88.0 has been added to Group 2 ICD-10 code list for rituximab and hyaluronidase human effective for dates of service on or after 01/01/2021.
Billing and Coding: Salvage High-intensity Focused Ultrasound (HIFU) Treatment in Prostate Cancer (PCa) (A56702)
CPT code C9747 was replaced by CPT code 55880, effective for services rendered on or after 1/1/2021.
*Due to the MCD update schedule for January 2021, coding changes, including added codes, deleted codes, and revised codes will not appear on the NGS website and Medicare Coverage database until after 1/28/2021.
Posted 12/23/2020