LCD and Article Revisions for June and July
The medical policies and related articles can be found in our Medical Policy Center.
New LCDs and Articles effective 7/1/2020
Multimarker Serum Tests Related to Ovarian Cancer Testing (L38371/A57020)
This is a noncoverage policy for all multi marker serum tests related to ovarian cancer testing.
LCDs Published on 6/25/2020
Noninvasive Vascular Studies (L33627)
LCD revised to correct typographical errors in CMS National Coverage Policy section.
Revised LCDs and Articles effective 7/1/2020
Molecular Pathology Procedures (L35000)
Based on a Reconsideration Request, added CYP2C9 testing which is indicated for the treatment of relapsing forms of multiple sclerosis and requires CYP2C9 genotyping for dosing in accordance with the FDA prescribing information. CYP2C9 testing must include the *1, *2 and *3 alleles that are necessary to safely dose the FDA-approved drug Mayzent, effective for services rendered on or after 7/1/2020.
Billing and Coding Article: Molecular Pathology Procedures (A56199)
Deleted 81227 from the CPT/HCPCS section Group 3 and added CPT code 81227 to the “CPT/HCPCS section” Group 1.
Added 81227 to the “ICD-10-CM that support Medically Necessity section-Group 35
Added the following explanatory language to the Article Text: Use 81227 for CYP2C9 genotyping for individuals who have a relapsing form of multiple sclerosis, and require CYP2C9 genotyping for dosing in accordance with the FDA prescribing information for Mayzent. CYP2C9 testing must include the *1, *2 and *3 alleles that are necessary to safely dose the FDA-approved drug Mayzent.
Retired LCD and Articles effective 7/1/2020:
Category III CPT® Codes (L33392/A56195)
Noncovered Services (L33629/A57812)
Effective 7/1/2020, NGS is retiring the Noncovered Services LCD (L33629) and Billing and Coding Article (A57812), AND the Category III CPT® Codes LCD (L33392) and Billing and Coding Article (A56195), to reflect recent changes to Chapter 13 of the Program Integrity Manual.
For the noncovered Services LCD, provisions for the following services will be moved to the LCDs listed:
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- Combined Ovarian Cancer Biomarker Tests – will move to L38371/A57020 (Multimarker Serum Tests Related to Ovarian Cancer Testing)
- Quantitative calcium scoring – will remain non-covered under LCD L33559/A56737 (Cardiac Computed Tomography [CCT] and Coronary Computed Tomography Angiography [CCTA])
For all services previously covered under these two LCDs, local policy rules, requirements, and limitations will no longer be applied on a prepay basis, but as with any billed service, claims may be subject to postpay review. All CMS national policy rules, requirements and limitations remain in effect.
Posted 6/23/2020