Trigger Points, Local Injections (L30155)
Contractor Information
|
Contractor Name Wisconsin Physicians Service Insurance Corporation |
Contractor Number 00951, 00952, 00953, 00954, 52280, 05101, 05201, 05301, 05401, 05102, 05202, 05302, 05402 |
Contractor Type Carrier - FI - MAC |
LCD Information
Document Information
L30155 LCD Title Trigger Points, Local Injections Contractor's Determination Number MS-008 AMA CPT/ADA CDT Copyright Statement CPT codes, descriptions and other data only are copyright 2010 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. |
Primary Geographic Jurisdiction
Oversight Region Original Determination Effective Date For services performed on or after 10/16/2009 Original Determination Ending Date Revision Effective Date For services performed on or after 03/01/2012 Revision Ending Date |
CMS National Coverage Policy
Title XVIII of the Social Security Act, section 1862(a)(1)(A). This section allows coverage and payment for only those services that are considered to be medically reasonable and necessary.
Title XVIII of the Social Security Act, section 1833(e). This section prohibits Medicare payment for any claim which lacks the necessary information to process the claim.
Title XVIII of the Social Security Act, section 1862 (a)(7) excludes routine physical evaluations.
PUB 100-03 Medicare National Coverage Determinations (NCD) Manual- Chapter 1 Section:
30.3 Acupuncture
150.7 - Prolotherapy, Joint Sclerotherapy, and Ligamentous Injections with Sclerosing Agents
Title XVIII of the Social Security Act, section 1833(e). This section prohibits Medicare payment for any claim which lacks the necessary information to process the claim.
Title XVIII of the Social Security Act, section 1862 (a)(7) excludes routine physical evaluations.
PUB 100-03 Medicare National Coverage Determinations (NCD) Manual- Chapter 1 Section:
30.3 Acupuncture
150.7 - Prolotherapy, Joint Sclerotherapy, and Ligamentous Injections with Sclerosing Agents
Indications and Limitations of Coverage and/or Medical Necessity
Indications and Limitations of Coverage and/or Medical Necessity
Myofascial trigger points are self-sustaining hyper-irritative foci that may occur in any skeletal muscle in response to strain produced by acute or chronic overload. These trigger points produce a referred pain pattern characteristic for that individual muscle. Each pattern becomes part of a single muscle myofascial pain syndrome (MPS); each of these single muscle syndromes is responsive to appropriate treatment. To successfully treat chronic myofascial pain syndrome, each single muscle syndrome needs to be identified along with every perpetuating factor.
There is no laboratory or imaging test for establishing the diagnosis of trigger points; it depends therefore, upon the detailed history and thorough directed examination. The following clinical features are present most consistently and are helpful in making the diagnosis:
1. history of onset and its cause (injury, sprain, etc.);
2. distribution of pain;
3. restriction of movement;
4. mild muscle specific weakness;
5. focal tenderness of a trigger point;
6. palpable taut band of muscle in which trigger point is located;
7. local taut response to snapping palpitation; and
8. reproduction of referred pain pattern upon most sustained mechanical stimulation of the trigger point.
The goal is to identify and treat the cause of the pain and not just the symptom of pain.
After making the diagnosis of myofascial pain syndrome and identifying the trigger point responsible for it, the treatment options are:
1. medical management, including the use of anti-inflammatory agents, tricyclics, etc.;
2. stretch and use of coolant spray followed by hot packs and/or aerobic exercises;
3. application of low intensity ultrasound directed at the trigger point (this approach is used when the trigger point is otherwise inaccessible);
4. deep muscle massage;
5. injection of local anesthetic into the muscle trigger points:
a. as the initial or the only therapy when a joint movement is mechanically blocked, as is the case of coccygeus muscle, or when a muscle cannot be stretched fully, as is the case of the lateral pterygoid muscle;
b. as treatment of trigger points that are unresponsive to non-invasive methods of treatment, e.g., use of medications, stretch and spray.
NOTE: For all conditions, the actual area must be reported specifically and must be documented in the medical record. Using a non-specific ICD-9-CM code to support injections of multiple areas of the body, rather than more specific ICD-9-CM codes, may result in denial of payment.
1. Known trigger points may be treated at frequencies necessitated by the nature and the severity of associated symptoms and signs.
2. Per national Medicare regulations acupuncture is not a covered service, even if provided for treatment of established trigger point:
a. Use of acupuncture needles and/or the passage of electrical current through these needles is not a covered service whether the service is rendered by an acupuncturist or any other provider;
b. providers of acupuncture services should inform the beneficiary that such services will not be covered; and
c. prolotherapy is not covered by Medicare and cannot be billed under the trigger point injection code.
3. If the service has been provided for a diagnosis that is not listed in the covered ICD-9-CM codes section, the provider must thoroughly document the medical necessity and rationale for providing the service for the unlisted diagnosis in the patient's medical records and this must be provided at the review level for consideration.
The ICD-9-CM codes listed as covered should only be used for purposes of this policy when a trigger point is injected. The ICD-9-CM codes listed should be correlated to the muscles as listed below.
ICD-9 codes 729.0, 729.1 and 729.4 are commonly used to indicate myofascial syndrome and are not associated with specific muscles listed below; therefore, documentation must be maintained noting the anatomic location of the injection site (s).
720.1 Serratus anterior; Serratus posterior; Quadratus lumborum; Longissimus thoracis; Lower thoracic iliocostalis; Upper & lower rectus abdominus; Upper lumbar iliocostalis; Multifidus; External oblique; McBurney's point
723.9 Trapezius (upper & lower); Sternocleidomastoid (cervical & sternal); Masseter; Temporalis; Lateral Pterygoid; Splenii; Posterior Cervical; Suboccipital
726.19 Scaleni; Subscapularis; Levator Scapulae; Brachialis; Deltoid (anterior & posterior); Middle finger extensor; Rhomboid, Infraspinatus / Supraspinatus; First dorsal Interosseous; Pectoralis Major and Minor; Supinator; Latissimus Dorsi
726.39 Triceps; Extensor Carpi Radialiss; Middle Finger Flexor
726.5 Glutei; Piriformis; Adductor Longus & Brevis
726.71 Soleus; Gastroenemius
726.72 Tibialis Anterior
726.79 Peroneus Longus & Brevis; Extensor Digitorum & Hallucis Longus; Third Dorsal Interosseous
726.90 Rectus Femoris; Vastus Intermedius; Vastus Medialis; Vastus Lateralis (anterior & posterior); Biceps Femoral
729.0 Muscles identified in the medical record of the injection site(s).
729.1 Muscles identified in the medical record of the injection site(s).
729.4 Muscles identified in the medical record of the injection site(s).
Myofascial trigger points are self-sustaining hyper-irritative foci that may occur in any skeletal muscle in response to strain produced by acute or chronic overload. These trigger points produce a referred pain pattern characteristic for that individual muscle. Each pattern becomes part of a single muscle myofascial pain syndrome (MPS); each of these single muscle syndromes is responsive to appropriate treatment. To successfully treat chronic myofascial pain syndrome, each single muscle syndrome needs to be identified along with every perpetuating factor.
There is no laboratory or imaging test for establishing the diagnosis of trigger points; it depends therefore, upon the detailed history and thorough directed examination. The following clinical features are present most consistently and are helpful in making the diagnosis:
1. history of onset and its cause (injury, sprain, etc.);
2. distribution of pain;
3. restriction of movement;
4. mild muscle specific weakness;
5. focal tenderness of a trigger point;
6. palpable taut band of muscle in which trigger point is located;
7. local taut response to snapping palpitation; and
8. reproduction of referred pain pattern upon most sustained mechanical stimulation of the trigger point.
The goal is to identify and treat the cause of the pain and not just the symptom of pain.
After making the diagnosis of myofascial pain syndrome and identifying the trigger point responsible for it, the treatment options are:
1. medical management, including the use of anti-inflammatory agents, tricyclics, etc.;
2. stretch and use of coolant spray followed by hot packs and/or aerobic exercises;
3. application of low intensity ultrasound directed at the trigger point (this approach is used when the trigger point is otherwise inaccessible);
4. deep muscle massage;
5. injection of local anesthetic into the muscle trigger points:
a. as the initial or the only therapy when a joint movement is mechanically blocked, as is the case of coccygeus muscle, or when a muscle cannot be stretched fully, as is the case of the lateral pterygoid muscle;
b. as treatment of trigger points that are unresponsive to non-invasive methods of treatment, e.g., use of medications, stretch and spray.
NOTE: For all conditions, the actual area must be reported specifically and must be documented in the medical record. Using a non-specific ICD-9-CM code to support injections of multiple areas of the body, rather than more specific ICD-9-CM codes, may result in denial of payment.
1. Known trigger points may be treated at frequencies necessitated by the nature and the severity of associated symptoms and signs.
2. Per national Medicare regulations acupuncture is not a covered service, even if provided for treatment of established trigger point:
a. Use of acupuncture needles and/or the passage of electrical current through these needles is not a covered service whether the service is rendered by an acupuncturist or any other provider;
b. providers of acupuncture services should inform the beneficiary that such services will not be covered; and
c. prolotherapy is not covered by Medicare and cannot be billed under the trigger point injection code.
3. If the service has been provided for a diagnosis that is not listed in the covered ICD-9-CM codes section, the provider must thoroughly document the medical necessity and rationale for providing the service for the unlisted diagnosis in the patient's medical records and this must be provided at the review level for consideration.
The ICD-9-CM codes listed as covered should only be used for purposes of this policy when a trigger point is injected. The ICD-9-CM codes listed should be correlated to the muscles as listed below.
ICD-9 codes 729.0, 729.1 and 729.4 are commonly used to indicate myofascial syndrome and are not associated with specific muscles listed below; therefore, documentation must be maintained noting the anatomic location of the injection site (s).
720.1 Serratus anterior; Serratus posterior; Quadratus lumborum; Longissimus thoracis; Lower thoracic iliocostalis; Upper & lower rectus abdominus; Upper lumbar iliocostalis; Multifidus; External oblique; McBurney's point
723.9 Trapezius (upper & lower); Sternocleidomastoid (cervical & sternal); Masseter; Temporalis; Lateral Pterygoid; Splenii; Posterior Cervical; Suboccipital
726.19 Scaleni; Subscapularis; Levator Scapulae; Brachialis; Deltoid (anterior & posterior); Middle finger extensor; Rhomboid, Infraspinatus / Supraspinatus; First dorsal Interosseous; Pectoralis Major and Minor; Supinator; Latissimus Dorsi
726.39 Triceps; Extensor Carpi Radialiss; Middle Finger Flexor
726.5 Glutei; Piriformis; Adductor Longus & Brevis
726.71 Soleus; Gastroenemius
726.72 Tibialis Anterior
726.79 Peroneus Longus & Brevis; Extensor Digitorum & Hallucis Longus; Third Dorsal Interosseous
726.90 Rectus Femoris; Vastus Intermedius; Vastus Medialis; Vastus Lateralis (anterior & posterior); Biceps Femoral
729.0 Muscles identified in the medical record of the injection site(s).
729.1 Muscles identified in the medical record of the injection site(s).
729.4 Muscles identified in the medical record of the injection site(s).
Coding Information
Bill Type Codes:
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
| 011x | Hospital Inpatient (Including Medicare Part A) |
| 012x | Hospital Inpatient (Medicare Part B only) |
| 013x | Hospital Outpatient |
| 018x | Hospital - Swing Beds |
| 021x | Skilled Nursing - Inpatient (Including Medicare Part A) |
| 022x | Skilled Nursing - Inpatient (Medicare Part B only) |
| 023x | Skilled Nursing - Outpatient |
| 071x | Clinic - Rural Health |
| 073x | Clinic - Freestanding |
| 075x | Clinic - Comprehensive Outpatient Rehabilitation Facility (CORF) |
| 083x | Ambulatory Surgery Center |
| 085x | Critical Access Hospital |
Revenue Codes:
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.
Revenue codes only apply to providers who bill these services to the fiscal intermediary. Revenue codes do not apply to physicians, other professionals and suppliers who bill these services to the carrier.
Please note that not all revenue codes apply to every type of bill code. Providers are encouraged to refer to the FISS revenue code file for allowable bill types. Similarly, not all revenue codes apply to each CPT/HCPCS code. Providers are encouraged to refer to the FISS HCPCS file for allowable revenue codes.
All revenue codes billed on the inpatient claim for the dates of service in question may be subject to review.
Revenue codes 096X, 097X and 098X are to be used only by Critical Access Hospitals (CAHs) choosing the optional payment method (also called Option 2 or Method 2) and only for services performed by physicians or practitioners who have reassigned their billing rights. When a CAH has selected the optional payment method, physicians or other practitioners providing professional services at the CAH may elect to bill their carrier or assign their billing rights to the CAH. When professional services are reassigned to the CAH, the CAH must bill the FI using revenue codes 096X, 097X or 098X.
CPT/HCPCS Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.
Revenue CodesContractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.
Revenue codes only apply to providers who bill these services to the fiscal intermediary. Revenue codes do not apply to physicians, other professionals and suppliers who bill these services to the carrier.
Please note that not all revenue codes apply to every type of bill code. Providers are encouraged to refer to the FISS revenue code file for allowable bill types. Similarly, not all revenue codes apply to each CPT/HCPCS code. Providers are encouraged to refer to the FISS HCPCS file for allowable revenue codes.
All revenue codes billed on the inpatient claim for the dates of service in question may be subject to review.
Revenue codes 096X, 097X and 098X are to be used only by Critical Access Hospitals (CAHs) choosing the optional payment method (also called Option 2 or Method 2) and only for services performed by physicians or practitioners who have reassigned their billing rights. When a CAH has selected the optional payment method, physicians or other practitioners providing professional services at the CAH may elect to bill their carrier or assign their billing rights to the CAH. When professional services are reassigned to the CAH, the CAH must bill the FI using revenue codes 096X, 097X or 098X.
| 0360 | Operating Room Services - General Classification |
| 0450 | Emergency Room - General Classification |
| 490X | Ambulatory Surgical Care - General Classification |
| 500X | Outpatient Services - General Classification |
| 510X | Clinic - General Classification |
| 520X | Free-Standing Clinic - General Classification |
| 0761 | Specialty Services - Treatment Room |
| 960X | Professional Fees - General Classification |
| 20552 | INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), 1 OR 2 MUSCLE(S) |
| 20553 | INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), 3 OR MORE MUSCLE(S) |
ICD-9 Codes that Support Medical Necessity
ICD-9 Codes that Support Medical Necessity
Note: ICD-9 codes must be coded to the highest level of specificity.
Note: ICD-9 codes must be coded to the highest level of specificity.
| 720.1 | SPINAL ENTHESOPATHY |
| 723.9 | UNSPECIFIED MUSCULOSKELETAL DISORDERS AND SYMPTOMS REFERABLE TO NECK |
| 726.19 | OTHER SPECIFIED DISORDERS OF BURSAE AND TENDONS IN SHOULDER REGION |
| 726.39 | OTHER ENTHESOPATHY OF ELBOW REGION |
| 726.5 | ENTHESOPATHY OF HIP REGION |
| 726.71 - 726.72 | ACHILLES BURSITIS OR TENDINITIS - TIBIALIS TENDINITIS |
| 726.79 | OTHER ENTHESOPATHY OF ANKLE AND TARSUS |
| 726.90 | ENTHESOPATHY OF UNSPECIFIED SITE |
| 729.0 | RHEUMATISM UNSPECIFIED AND FIBROSITIS |
| 729.1 | MYALGIA AND MYOSITIS UNSPECIFIED |
| 729.4 | FASCIITIS UNSPECIFIED |
Diagnoses that Support Medical Necessity
ICD-9 Codes that DO NOT Support Medical Necessity
ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation
Diagnoses that DO NOT Support Medical Necessity
General Information
Documentation Requirements
1. Documentation of proper evaluation leading to diagnosis of the trigger point.
2. Identification of the affected muscle(s).
3. Documentation of reasons for selecting this therapeutic option.
4. Precise diagnosis code must be used: generalized diagnoses like low back pain, lumbago, etc. will not be covered.
5. Documentation which includes the frequency of injections.
6. Documentation must reflect the medical necessity of providing the service. In a post payment review, the process of making the diagnosis of the trigger point in an individual muscle as detailed in the description section must be documented.
7. If a patient requires more than 4 sets/series of injections during one year, (trigger points in different anatomical locations), a report stating the unusual circumstances and medical necessity for giving the additional injections must accompany the claim for review and individual consideration.
1. Documentation of proper evaluation leading to diagnosis of the trigger point.
2. Identification of the affected muscle(s).
3. Documentation of reasons for selecting this therapeutic option.
4. Precise diagnosis code must be used: generalized diagnoses like low back pain, lumbago, etc. will not be covered.
5. Documentation which includes the frequency of injections.
6. Documentation must reflect the medical necessity of providing the service. In a post payment review, the process of making the diagnosis of the trigger point in an individual muscle as detailed in the description section must be documented.
7. If a patient requires more than 4 sets/series of injections during one year, (trigger points in different anatomical locations), a report stating the unusual circumstances and medical necessity for giving the additional injections must accompany the claim for review and individual consideration.
Appendices
Utilization Guidelines
Utilization Guidelines
Repeat trigger point injections may be necessary when there is evidence of persistent pain. Generally more than three injections of the same trigger point are not indicated. Evidence of partial improvements to the range of motion in any muscle area after an injection, but with persistent significant pain, would justify a repeat injection. The medical record must clearly reflect the medical necessity of the repeat injections.
Only one Trigger Point Injection CPT code can be billed per date of service.
Because the ICD-9-CM manual does not list "trigger point" or "myofascial pain syndrome," this LCD lists related diagnoses that can reasonably include trigger points and uses "myofascial pain syndrome" to refer to trigger points.
Repeat trigger point injections may be necessary when there is evidence of persistent pain. Generally more than three injections of the same trigger point are not indicated. Evidence of partial improvements to the range of motion in any muscle area after an injection, but with persistent significant pain, would justify a repeat injection. The medical record must clearly reflect the medical necessity of the repeat injections.
Only one Trigger Point Injection CPT code can be billed per date of service.
Because the ICD-9-CM manual does not list "trigger point" or "myofascial pain syndrome," this LCD lists related diagnoses that can reasonably include trigger points and uses "myofascial pain syndrome" to refer to trigger points.
Sources of Information and Basis for Decision
Other Medicare Contractors Local Coverage Determinations
Alvarez, D. Rockwell, P. Trigger points: diagnosis and management. Am Fam
Physician. 2002; 65: 653-60.
Tollison, CD, ed. Handbook of Pain Management. 2nd ed. Baltimore: Williams & Wilkins; 1994.
Alvarez, D. Rockwell, P. Trigger points: diagnosis and management. Am Fam
Physician. 2002; 65: 653-60.
Tollison, CD, ed. Handbook of Pain Management. 2nd ed. Baltimore: Williams & Wilkins; 1994.
Advisory Committee Meeting Notes
Meeting Date:
Wisconsin 05/15/2009
Illinois 05/13/2009
Michigan 05/06/2009
Minnesota 05/21/2009
J5 MAC 06/04/2009
Open Meeting 4/15/2009
Wisconsin 05/15/2009
Illinois 05/13/2009
Michigan 05/06/2009
Minnesota 05/21/2009
J5 MAC 06/04/2009
Open Meeting 4/15/2009
Start Date of Comment Period
06/04/2009
End Date of Comment Period
07/20/2009
Start Date of Notice Period
09/01/2009
Revision History Number
x
Revision History Explanation
11/03/2009 Added comment/notice period dates.
08/14/2009 Revised and released to final effective 10/16/2009
8/10/2009 - The description for Revenue code 0761 was changed
Removed contractor number 05392 E MO. This number is being joined with W MO to include all of MO under one contractor number effective 8/01/2009.
04/03/2009 Approved
04/03/2009 Entered as draft
3/7/2010 - The description for Bill Type Code 73 was changed
04/19/2010 In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of American Somoa, California, Guam, Hawaii, Nevada and Northern Mariana Islands were removed from this LCD because claims processing for those states are transitioning from FI Contractor Wisconsin Physician Services (WPS - 52280) to MAC Part A Contractor Palmetto.
8/1/2010 - The description for Bill Type Code 11 was changed
8/1/2010 - The description for Bill Type Code 12 was changed
8/1/2010 - The description for Bill Type Code 13 was changed
8/1/2010 - The description for Bill Type Code 18 was changed
8/1/2010 - The description for Bill Type Code 21 was changed
8/1/2010 - The description for Bill Type Code 22 was changed
8/1/2010 - The description for Bill Type Code 23 was changed
8/1/2010 - The description for Bill Type Code 71 was changed
8/1/2010 - The description for Bill Type Code 73 was changed
8/1/2010 - The description for Bill Type Code 75 was changed
8/1/2010 - The description for Bill Type Code 83 was changed
8/1/2010 - The description for Bill Type Code 85 was changed
8/1/2010 - The description for Revenue code 0360 was changed
8/1/2010 - The description for Revenue code 0450 was changed
8/1/2010 - The description for Revenue code 0490 was changed
8/1/2010 - The description for Revenue code 0499 was changed
8/1/2010 - The description for Revenue code 0500 was changed
8/1/2010 - The description for Revenue code 0509 was changed
8/1/2010 - The description for Revenue code 0510 was changed
8/1/2010 - The description for Revenue code 0511 was changed
8/1/2010 - The description for Revenue code 0512 was changed
8/1/2010 - The description for Revenue code 0513 was changed
8/1/2010 - The description for Revenue code 0514 was changed
8/1/2010 - The description for Revenue code 0515 was changed
8/1/2010 - The description for Revenue code 0516 was changed
8/1/2010 - The description for Revenue code 0517 was changed
8/1/2010 - The description for Revenue code 0519 was changed
8/1/2010 - The description for Revenue code 0520 was changed
8/1/2010 - The description for Revenue code 0521 was changed
8/1/2010 - The description for Revenue code 0522 was changed
8/1/2010 - The description for Revenue code 0523 was changed
8/1/2010 - The description for Revenue code 0524 was changed
8/1/2010 - The description for Revenue code 0525 was changed
8/1/2010 - The description for Revenue code 0526 was changed
8/1/2010 - The description for Revenue code 0527 was changed
8/1/2010 - The description for Revenue code 0528 was changed
8/1/2010 - The description for Revenue code 0529 was changed
8/1/2010 - The description for Revenue code 0761 was changed
8/1/2010 - The description for Revenue code 0960 was changed
8/1/2010 - The description for Revenue code 0961 was changed
8/1/2010 - The description for Revenue code 0962 was changed
8/1/2010 - The description for Revenue code 0963 was changed
8/1/2010 - The description for Revenue code 0964 was changed
8/1/2010 - The description for Revenue code 0969 was changed
10/18/2010 - In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of Colorado, New Mexico, Oklahoma and Texas were removed from this LCD because claims processing for those states are transitioning from FI Wisconsin Physicians Service (52280) to MAC Part A Trailblazer (04901).
11/21/2010 - For the following CPT/HCPCS codes either the short description and/or the long description was changed. Depending on which description is used in this LCD, there may not be any change in how the code displays in the document:
20552 descriptor was changed in Group 1
20553 descriptor was changed in Group 1
01/14/2011 Annual review no change in coverage.
02/21/2011 In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of Delaware, District of Columbia, Maryland, New Jersey and Pennsylvania were removed from this LCD because claims processing for these states are transitioning from FI Wisconsin Physician Service (WPS 52280) to MAC Part A contractor Highmark (12901).
03/01/2012 Annual review no change in coverage
08/14/2009 Revised and released to final effective 10/16/2009
8/10/2009 - The description for Revenue code 0761 was changed
Removed contractor number 05392 E MO. This number is being joined with W MO to include all of MO under one contractor number effective 8/01/2009.
04/03/2009 Approved
04/03/2009 Entered as draft
3/7/2010 - The description for Bill Type Code 73 was changed
04/19/2010 In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of American Somoa, California, Guam, Hawaii, Nevada and Northern Mariana Islands were removed from this LCD because claims processing for those states are transitioning from FI Contractor Wisconsin Physician Services (WPS - 52280) to MAC Part A Contractor Palmetto.
8/1/2010 - The description for Bill Type Code 11 was changed
8/1/2010 - The description for Bill Type Code 12 was changed
8/1/2010 - The description for Bill Type Code 13 was changed
8/1/2010 - The description for Bill Type Code 18 was changed
8/1/2010 - The description for Bill Type Code 21 was changed
8/1/2010 - The description for Bill Type Code 22 was changed
8/1/2010 - The description for Bill Type Code 23 was changed
8/1/2010 - The description for Bill Type Code 71 was changed
8/1/2010 - The description for Bill Type Code 73 was changed
8/1/2010 - The description for Bill Type Code 75 was changed
8/1/2010 - The description for Bill Type Code 83 was changed
8/1/2010 - The description for Bill Type Code 85 was changed
8/1/2010 - The description for Revenue code 0360 was changed
8/1/2010 - The description for Revenue code 0450 was changed
8/1/2010 - The description for Revenue code 0490 was changed
8/1/2010 - The description for Revenue code 0499 was changed
8/1/2010 - The description for Revenue code 0500 was changed
8/1/2010 - The description for Revenue code 0509 was changed
8/1/2010 - The description for Revenue code 0510 was changed
8/1/2010 - The description for Revenue code 0511 was changed
8/1/2010 - The description for Revenue code 0512 was changed
8/1/2010 - The description for Revenue code 0513 was changed
8/1/2010 - The description for Revenue code 0514 was changed
8/1/2010 - The description for Revenue code 0515 was changed
8/1/2010 - The description for Revenue code 0516 was changed
8/1/2010 - The description for Revenue code 0517 was changed
8/1/2010 - The description for Revenue code 0519 was changed
8/1/2010 - The description for Revenue code 0520 was changed
8/1/2010 - The description for Revenue code 0521 was changed
8/1/2010 - The description for Revenue code 0522 was changed
8/1/2010 - The description for Revenue code 0523 was changed
8/1/2010 - The description for Revenue code 0524 was changed
8/1/2010 - The description for Revenue code 0525 was changed
8/1/2010 - The description for Revenue code 0526 was changed
8/1/2010 - The description for Revenue code 0527 was changed
8/1/2010 - The description for Revenue code 0528 was changed
8/1/2010 - The description for Revenue code 0529 was changed
8/1/2010 - The description for Revenue code 0761 was changed
8/1/2010 - The description for Revenue code 0960 was changed
8/1/2010 - The description for Revenue code 0961 was changed
8/1/2010 - The description for Revenue code 0962 was changed
8/1/2010 - The description for Revenue code 0963 was changed
8/1/2010 - The description for Revenue code 0964 was changed
8/1/2010 - The description for Revenue code 0969 was changed
10/18/2010 - In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of Colorado, New Mexico, Oklahoma and Texas were removed from this LCD because claims processing for those states are transitioning from FI Wisconsin Physicians Service (52280) to MAC Part A Trailblazer (04901).
11/21/2010 - For the following CPT/HCPCS codes either the short description and/or the long description was changed. Depending on which description is used in this LCD, there may not be any change in how the code displays in the document:
20552 descriptor was changed in Group 1
20553 descriptor was changed in Group 1
01/14/2011 Annual review no change in coverage.
02/21/2011 In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of Delaware, District of Columbia, Maryland, New Jersey and Pennsylvania were removed from this LCD because claims processing for these states are transitioning from FI Wisconsin Physician Service (WPS 52280) to MAC Part A contractor Highmark (12901).
03/01/2012 Annual review no change in coverage
Reason for Change
Maintenance (annual review with new changes, formatting, etc.)
Related Documents
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