Vertebroplasty (Percutaneous) and Vertebral Augmentation including cavity creation (L30516)
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
L30516 LCD Title Vertebroplasty (Percutaneous) and Vertebral Augmentation including cavity creation Contractor's Determination Number RAD-032 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 07/16/2010 Original Determination Ending Date Revision Effective Date For services performed on or after 06/01/2011 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 of those services that are considered to be
medically reasonable and necessary.
Title XVIII of the Social Security Act section 1862 (a)(7). This section excludes routine physical examinations and services
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). This section excludes routine physical examinations and services
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.
Indications and Limitations of Coverage and/or Medical Necessity
A. Description:
Compression fractures and neoplastic conditions affecting vertebral bodies can result in pain and/or disability. The therapeutic options have focused on reduction of pain and have included bed rest, narcotic analgesics, braces and surgery. Newer treatment options include percutaneous vertebroplasty and vertebral augmentation including cavity creation.
Percutaneous Vertebroplasty is a therapeutic procedure which consists of the injection of a biomaterial (usually polymethylmethacrylate) under imaging guidance (either fluoroscopy or CT) into a cervical, thoracic, or lumbar vertebral body stabilizing the fractured vertebral body which facilitates restoring mobility and decreasing disability and pain. Percutaneous vertebroplasty may be performed as an outpatient procedure.
Vertebral augmentation including cavity creation, while different, is another minimally invasive procedure used to treat vertebral compression fractures. Using fluoroscopic or CT guidance, a bone tamp is inserted into the vertebral body. The defect produced by the tamp is filled with a bone substitute or cement (e.g., polymethylmethacrylate) or other device displacing (removing) (compacting) bone to create a space (cavity) (void) prior to the injection of bone void filler (cement) (polymethylmethacrylate) (PMMA).
B. Indications
The principal indications for percutaneous vertebroplasty and vertebral augmentation including cavity creation are listed as follows:
1. Painful osteolytic metastasis;
2. Multiple myeloma with painful vertebral body involvement;
3. Painful and/or aggressive hemangiomas;
4. Osteoporotic vertebral collapse with persistent debilitating pain, which has not responded to, accepted standard medical treatment;
5. Unstable fractures due to osteoporosis (Kummell's Disease);
6. Steroid-induced fractures;
7. Reinforcement or stabilization of vertebral body prior to surgery;
8. Painful vertebral eosinophilic granuloma with spinal instability.
The decision for treatment should be multidisciplinary and take into consideration the local and general extent of the disease, the spinal level involved, the severity of pain experienced by the patient as well as his or her neurologic condition, previous treatments and their outcomes, the general state of health and life expectancy.
Percutaneous Vertebroplasty or Vertebral Augmentation including cavity creation is not to be considered a prophylactic procedure for osteoporosis of the spine. It also should not be used for chronic back pain of long-standing duration, even if associated with old compression fractures, unless pain is localized to a specific chronic fracture and medical therapy has failed.
C. Limitations of Coverage
Percutaneous vertebroplasty/ vertebral augmentation including cavity creation is contraindicated for the following:
1. Uncorrected coagulation disorders
2. Presence of infection (local or systemic)
3. Known allergy to any of the materials used in either of the procedures
The following is a list of relative contraindications:
1. Extensive vertebral destruction;
2. Significant vertebral collapse in which the vertebra is less than 1/3 of its original height;
3. Neurologic symptoms related to spinal cord and nerve root compression;
4. Cervical vertebroplasty (However, in rare instances, these are performed by physicians who are highly skilled in this procedure).
If percutaneous vertebroplasty or vertebral augmentation including cavity creation is performed despite a relative contraindication, the medical record must clearly document the rationale for this decision.
Compression fractures and neoplastic conditions affecting vertebral bodies can result in pain and/or disability. The therapeutic options have focused on reduction of pain and have included bed rest, narcotic analgesics, braces and surgery. Newer treatment options include percutaneous vertebroplasty and vertebral augmentation including cavity creation.
Percutaneous Vertebroplasty is a therapeutic procedure which consists of the injection of a biomaterial (usually polymethylmethacrylate) under imaging guidance (either fluoroscopy or CT) into a cervical, thoracic, or lumbar vertebral body stabilizing the fractured vertebral body which facilitates restoring mobility and decreasing disability and pain. Percutaneous vertebroplasty may be performed as an outpatient procedure.
Vertebral augmentation including cavity creation, while different, is another minimally invasive procedure used to treat vertebral compression fractures. Using fluoroscopic or CT guidance, a bone tamp is inserted into the vertebral body. The defect produced by the tamp is filled with a bone substitute or cement (e.g., polymethylmethacrylate) or other device displacing (removing) (compacting) bone to create a space (cavity) (void) prior to the injection of bone void filler (cement) (polymethylmethacrylate) (PMMA).
B. Indications
The principal indications for percutaneous vertebroplasty and vertebral augmentation including cavity creation are listed as follows:
1. Painful osteolytic metastasis;
2. Multiple myeloma with painful vertebral body involvement;
3. Painful and/or aggressive hemangiomas;
4. Osteoporotic vertebral collapse with persistent debilitating pain, which has not responded to, accepted standard medical treatment;
5. Unstable fractures due to osteoporosis (Kummell's Disease);
6. Steroid-induced fractures;
7. Reinforcement or stabilization of vertebral body prior to surgery;
8. Painful vertebral eosinophilic granuloma with spinal instability.
The decision for treatment should be multidisciplinary and take into consideration the local and general extent of the disease, the spinal level involved, the severity of pain experienced by the patient as well as his or her neurologic condition, previous treatments and their outcomes, the general state of health and life expectancy.
Percutaneous Vertebroplasty or Vertebral Augmentation including cavity creation is not to be considered a prophylactic procedure for osteoporosis of the spine. It also should not be used for chronic back pain of long-standing duration, even if associated with old compression fractures, unless pain is localized to a specific chronic fracture and medical therapy has failed.
C. Limitations of Coverage
Percutaneous vertebroplasty/ vertebral augmentation including cavity creation is contraindicated for the following:
1. Uncorrected coagulation disorders
2. Presence of infection (local or systemic)
3. Known allergy to any of the materials used in either of the procedures
The following is a list of relative contraindications:
1. Extensive vertebral destruction;
2. Significant vertebral collapse in which the vertebra is less than 1/3 of its original height;
3. Neurologic symptoms related to spinal cord and nerve root compression;
4. Cervical vertebroplasty (However, in rare instances, these are performed by physicians who are highly skilled in this procedure).
If percutaneous vertebroplasty or vertebral augmentation including cavity creation is performed despite a relative contraindication, the medical record must clearly document the rationale for this decision.
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.
| 012x | Hospital Inpatient (Medicare Part B only) |
| 013x | Hospital Outpatient |
| 022x | Skilled Nursing - Inpatient (Medicare Part B only) |
| 083x | Ambulatory Surgery Center |
| 085x | Critical Access Hospital |
Revenue Codes:
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.
| 0360 | Operating Room Services - General Classification |
| 520X | Free-Standing Clinic - General Classification |
| 0761 | Specialty Services - Treatment Room |
| 22520 | PERCUTANEOUS VERTEBROPLASTY, 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION; THORACIC |
| 22521 | PERCUTANEOUS VERTEBROPLASTY, 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION; LUMBAR |
| 22522 | PERCUTANEOUS VERTEBROPLASTY, 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION; EACH ADDITIONAL THORACIC OR LUMBAR VERTEBRAL BODY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 22523 | PERCUTANEOUS VERTEBRAL AUGMENTATION, INCLUDING CAVITY CREATION (FRACTURE REDUCTION AND BONE BIOPSY INCLUDED WHEN PERFORMED) USING MECHANICAL DEVICE, 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL CANNULATION (EG, KYPHOPLASTY); THORACIC |
| 22524 | PERCUTANEOUS VERTEBRAL AUGMENTATION, INCLUDING CAVITY CREATION (FRACTURE REDUCTION AND BONE BIOPSY INCLUDED WHEN PERFORMED) USING MECHANICAL DEVICE, 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL CANNULATION (EG, KYPHOPLASTY); LUMBAR |
| 22525 | PERCUTANEOUS VERTEBRAL AUGMENTATION, INCLUDING CAVITY CREATION (FRACTURE REDUCTION AND BONE BIOPSY INCLUDED WHEN PERFORMED) USING MECHANICAL DEVICE, 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL CANNULATION (EG, KYPHOPLASTY); EACH ADDITIONAL THORACIC OR LUMBAR VERTEBRAL BODY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 72291 | RADIOLOGICAL SUPERVISION AND INTERPRETATION, PERCUTANEOUS VERTEBROPLASTY, VERTEBRAL AUGMENTATION, OR SACRAL AUGMENTATION (SACROPLASTY), INCLUDING CAVITY CREATION, PER VERTEBRAL BODY OR SACRUM; UNDER FLUOROSCOPIC GUIDANCE |
| 72292 | RADIOLOGICAL SUPERVISION AND INTERPRETATION, PERCUTANEOUS VERTEBROPLASTY, VERTEBRAL AUGMENTATION, OR SACRAL AUGMENTATION (SACROPLASTY), INCLUDING CAVITY CREATION, PER VERTEBRAL BODY OR SACRUM; UNDER CT GUIDANCE |
ICD-9 Codes that Support Medical Necessity
| 170.2 | MALIGNANT NEOPLASM OF VERTEBRAL COLUMN EXCLUDING SACRUM AND COCCYX |
| 198.5 | SECONDARY MALIGNANT NEOPLASM OF BONE AND BONE MARROW |
| 200.00 - 209.69 | RETICULOSARCOMA UNSPECIFIED SITE - BENIGN CARCINOID TUMOR OF OTHER SITES |
| 213.2 | BENIGN NEOPLASM OF VERTEBRAL COLUMN EXCLUDING SACRUM AND COCCYX |
| 228.09 | HEMANGIOMA OF OTHER SITES |
| 238.0 | NEOPLASM OF UNCERTAIN BEHAVIOR OF BONE AND ARTICULAR CARTILAGE |
| 238.6 | NEOPLASM OF UNCERTAIN BEHAVIOR OF PLASMA CELLS |
| 238.79 | OTHER LYMPHATIC AND HEMATOPOIETIC TISSUES |
| 239.2 | NEOPLASM OF UNSPECIFIED NATURE OF BONE SOFT TISSUE AND SKIN |
| 255.0 | CUSHING'S SYNDROME |
| 268.2 | OSTEOMALACIA UNSPECIFIED |
| 268.9 | UNSPECIFIED VITAMIN D DEFICIENCY |
| 275.40 | UNSPECIFIED DISORDER OF CALCIUM METABOLISM |
| 275.41 | HYPOCALCEMIA |
| 275.49 | OTHER DISORDERS OF CALCIUM METABOLISM |
| 277.81 | PRIMARY CARNITINE DEFICIENCY |
| 277.82 | CARNITINE DEFICIENCY DUE TO INBORN ERRORS OF METABOLISM |
| 277.83 | IATROGENIC CARNITINE DEFICIENCY |
| 277.84 | OTHER SECONDARY CARNITINE DEFICIENCY |
| 277.89 | OTHER SPECIFIED DISORDERS OF METABOLISM |
| 721.7 | TRAUMATIC SPONDYLOPATHY |
| 733.00 - 733.09 | OSTEOPOROSIS UNSPECIFIED - OTHER OSTEOPOROSIS |
| 733.13 | PATHOLOGICAL FRACTURE OF VERTEBRAE |
| 805.00 - 805.08 | CLOSED FRACTURE OF CERVICAL VERTEBRA UNSPECIFIED LEVEL - CLOSED FRACTURE OF MULTIPLE CERVICAL VERTEBRAE |
| 805.2 | CLOSED FRACTURE OF DORSAL (THORACIC) VERTEBRA WITHOUT SPINAL CORD INJURY |
| 805.4 | CLOSED FRACTURE OF LUMBAR VERTEBRA WITHOUT SPINAL CORD INJURY |
| 805.6 | CLOSED FRACTURE OF SACRUM AND COCCYX WITHOUT SPINAL CORD INJURY |
| 805.8 | CLOSED FRACTURE OF UNSPECIFIED PART OF VERTEBRAL COLUMN WITHOUT SPINAL CORD INJURY |
| 995.20 | UNSPECIFIED ADVERSE EFFECT OF UNSPECIFIED DRUG, MEDICINAL AND BIOLOGICAL SUBSTANCE |
Diagnoses that Support Medical Necessity
ICD-9 codes listed
ICD-9 Codes that DO NOT Support Medical Necessity
Those codes that are not listed in this policy
ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation
Diagnoses that DO NOT Support Medical Necessity
Those diagnoses that are not listed in this policy
General Information
Documentation
supporting the medical necessity of this item, such as ICD-9 codes, must
be submitted with each claim. Claims submitted without such evidence
will be denied as being not medically necessary.
The medical record must include documentation of the specific signs, symptoms and condition associated with the billed ICD-9 code. This information must be available to the carrier upon request.
To establish medical necessity the medical record must indicate that other non-invasive corrective medical treatment has been tried and failed.
Appendices
The medical record must include documentation of the specific signs, symptoms and condition associated with the billed ICD-9 code. This information must be available to the carrier upon request.
To establish medical necessity the medical record must indicate that other non-invasive corrective medical treatment has been tried and failed.
N/A
Sources of Information and Basis for Decision
1. Buchbinder R,
Osborne RH, Ebeling PR, Wark JD, Mitchell P, Wriedt C, Graves S, Staples
MP, Murphy B, A Randomized Trial of Vertebroplasty for Painful
Osteoporotic Vertebral Fractures. N Engl J Med 2009;361:557-68.
2. Kallmes DF, Comstock BA, Heagerty PJ, Turner JA, Wilson DJ, Diamond TH, Edwards R, Gray LA, Stout L, Owen S, Hollingworth W, Ghdoke B, Annesley-Williams DJ, Ralston SH, Jarvik JG, A Randomized Trial of Vertebroplasty for Osteoporotic Spinal Fractures N Engl J Med 2009;361:569-79.
3. Gray DT, Hollingsworth W, Onwudiwe N, Deyo RA, Jarvik JG, Thoracic and lumbar vertebroplasties performed in US Medicare enrollees, 2001-2005. J Am Med Ass 2007;298:1760-2.
4. Layton KF, Theilen KR, Koch CA, Leutmer PH, Lane JI, Wald JT, Kallmes DF, Vertebroplasty, first 1000 levels of a single center: evaluation of the outcomes and complications. Am J Neuroradiol 2007;28:683-9.
5. McKiernan FE Broadening the spectrum of osteoporotic vertebral compression fractures. Skeletal Radiology 2009;38:303-9.
6. Diamond TH, Bryant C, Browne L, Clark WA, Clinical outcomes after acute osteoporotic vertebral fractures: a 2-year non-randomized trial comparing percutaneous vertebroplasty with conservative therapy. Med J Australia 2006;184:113-7.
7. McKiernan FE, Faciszewski T, Jensen R Quality of life following percutaneous vertebroplasty. J Bone Joint Surg Am 2004;86-A:2600-6.
8. Voormolen MHJ, Mali WPTM, Lohle PNM, Fransen H, LAmpmann LEH, van der Graff Y, Juttmann JR, Janssens X, Verhaar HJJ, Percutaneous vertebroplasty compared with optimal pain medication treatment: short-term clinical outcome of patients with subacute or chronic painful osteoporotic vertebral compression fractures. The VERTOS study. Am J Neuroradiol 2007;28:555-60.
9. Wardlaw D, Cumings SR, van Meirhaeghe J, Bastian L, Tillman JB, Ranstam J, Eastell R, Shabe P, Talmadge K, Boonen S, Efficacy and safety of balloon kyphoplasty compared with non-surgical care foe vertebral compression fracture (FREE): a randomized controlled trial. Lancet2009;373:1016-24.
10. McKiernan FE. Kyphoplasty and vertebroplasty: how good is the evidence? Curr Rheumatol Reports; Osteoporosis and Metabolic Bone Diseases 2007;9(1):57-65.
11. Kallmes DF, et. al, A Randomized Trial of Vertebroplasty for Osteoporotic Spinal Fractures N Engl J Med 361:569-579, August 6, 2009
12. Buchbinder R, et al. A Randomized Trial of Vertebroplasty for Painful Osteoporotic Vertebral Fractures N Engl J Med 361:557-568, August 6, 2009
13. Clark W, Lyon S, Burnes J, Baerlocher MO, Munk PL, Liu DM, Lotz JC, Grey A, Bolland M, Buchbinder R, Osborne R, Staples M, Kallmes DF, Heagerty PJ, Jarvik JG, Weinstein JN Trials of Vertebroplasty for Vertebral Fractures, N Engl J Med 361:2097, November 19, 2009
This policy does not reflect the sole opinion of the contractor or the Contractor Medical Director(s). Although the final decision rests with the contractor, this policy was developed in cooperation with the Carrier Advisory Committee(s), which include representatives of various medical specialty societies.
Advisory Committee Meeting Notes
2. Kallmes DF, Comstock BA, Heagerty PJ, Turner JA, Wilson DJ, Diamond TH, Edwards R, Gray LA, Stout L, Owen S, Hollingworth W, Ghdoke B, Annesley-Williams DJ, Ralston SH, Jarvik JG, A Randomized Trial of Vertebroplasty for Osteoporotic Spinal Fractures N Engl J Med 2009;361:569-79.
3. Gray DT, Hollingsworth W, Onwudiwe N, Deyo RA, Jarvik JG, Thoracic and lumbar vertebroplasties performed in US Medicare enrollees, 2001-2005. J Am Med Ass 2007;298:1760-2.
4. Layton KF, Theilen KR, Koch CA, Leutmer PH, Lane JI, Wald JT, Kallmes DF, Vertebroplasty, first 1000 levels of a single center: evaluation of the outcomes and complications. Am J Neuroradiol 2007;28:683-9.
5. McKiernan FE Broadening the spectrum of osteoporotic vertebral compression fractures. Skeletal Radiology 2009;38:303-9.
6. Diamond TH, Bryant C, Browne L, Clark WA, Clinical outcomes after acute osteoporotic vertebral fractures: a 2-year non-randomized trial comparing percutaneous vertebroplasty with conservative therapy. Med J Australia 2006;184:113-7.
7. McKiernan FE, Faciszewski T, Jensen R Quality of life following percutaneous vertebroplasty. J Bone Joint Surg Am 2004;86-A:2600-6.
8. Voormolen MHJ, Mali WPTM, Lohle PNM, Fransen H, LAmpmann LEH, van der Graff Y, Juttmann JR, Janssens X, Verhaar HJJ, Percutaneous vertebroplasty compared with optimal pain medication treatment: short-term clinical outcome of patients with subacute or chronic painful osteoporotic vertebral compression fractures. The VERTOS study. Am J Neuroradiol 2007;28:555-60.
9. Wardlaw D, Cumings SR, van Meirhaeghe J, Bastian L, Tillman JB, Ranstam J, Eastell R, Shabe P, Talmadge K, Boonen S, Efficacy and safety of balloon kyphoplasty compared with non-surgical care foe vertebral compression fracture (FREE): a randomized controlled trial. Lancet2009;373:1016-24.
10. McKiernan FE. Kyphoplasty and vertebroplasty: how good is the evidence? Curr Rheumatol Reports; Osteoporosis and Metabolic Bone Diseases 2007;9(1):57-65.
11. Kallmes DF, et. al, A Randomized Trial of Vertebroplasty for Osteoporotic Spinal Fractures N Engl J Med 361:569-579, August 6, 2009
12. Buchbinder R, et al. A Randomized Trial of Vertebroplasty for Painful Osteoporotic Vertebral Fractures N Engl J Med 361:557-568, August 6, 2009
13. Clark W, Lyon S, Burnes J, Baerlocher MO, Munk PL, Liu DM, Lotz JC, Grey A, Bolland M, Buchbinder R, Osborne R, Staples M, Kallmes DF, Heagerty PJ, Jarvik JG, Weinstein JN Trials of Vertebroplasty for Vertebral Fractures, N Engl J Med 361:2097, November 19, 2009
This policy does not reflect the sole opinion of the contractor or the Contractor Medical Director(s). Although the final decision rests with the contractor, this policy was developed in cooperation with the Carrier Advisory Committee(s), which include representatives of various medical specialty societies.
Advisory Committee Meeting Notes
Meeting Date:
Wisconsin 9/25/2009
Illinois 9/16/2009
Michigan 9/09/2009
Minnesota 9/24/2009
Iowa 10/08/2009
Kansas 10/08/2009
Missouri 10/08/2009
Nebraska 10/08/2009
Jurisdictional Open Meeting 08/19/2009
Start Date of Comment Period
Meeting Date:
Wisconsin 9/25/2009
Illinois 9/16/2009
Michigan 9/09/2009
Minnesota 9/24/2009
Iowa 10/08/2009
Kansas 10/08/2009
Missouri 10/08/2009
Nebraska 10/08/2009
Jurisdictional Open Meeting 08/19/2009
10/08/2009
End Date of Comment Period
11/23/2009
Start Date of Notice Period
06/01/2010
Revision History Number
X
Revision History Explanation
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 22 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 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
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:
22523 descriptor was changed in Group 1
22524 descriptor was changed in Group 1
22525 descriptor was changed in Group 1
72291 descriptor was changed in Group 1
72292 descriptor was changed in Group 1
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).
06/01/2011, annual review, no changes
Reason for Change
8/1/2010 - The description for Bill Type Code 13 was changed
8/1/2010 - The description for Bill Type Code 22 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 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
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:
22523 descriptor was changed in Group 1
22524 descriptor was changed in Group 1
22525 descriptor was changed in Group 1
72291 descriptor was changed in Group 1
72292 descriptor was changed in Group 1
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).
06/01/2011, annual review, no changes
06/01/2011
Related Documents
This LCD has no Related Documents.
LCD Attachments
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