Surgical Treatment of Obstructive Sleep Apnea (OSA) (L30731)
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
L30731 LCD Title Surgical Treatment of Obstructive Sleep Apnea (OSA) Contractor's Determination Number ENT-012 AMA CPT/ADA CDT Copyright Statement CPT codes, descriptions and other data only are copyright 2011 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 11/01/2011 Revision Ending Date |
CMS National Coverage Policy
CMS Pub. 100-3 Medicare National Coverage Determinations Manual:
Ch.1 §240.4 Continuous Positive Airway Pressure (CPAP) Therapy For Obstructive Sleep Apnea (OSA)
CMS Pub. 100-02 Medicare Benefit Policy Manual
Ch.15 §70- Sleep Disorder Clinics
Ch.16 §140 Dental Services Exclusion
1862 (a)(1)(A) Medically Reasonable & Necessary.
1862 (a)(1)(D) Investigational or Experimental.
Ch.1 §240.4 Continuous Positive Airway Pressure (CPAP) Therapy For Obstructive Sleep Apnea (OSA)
CMS Pub. 100-02 Medicare Benefit Policy Manual
Ch.15 §70- Sleep Disorder Clinics
Ch.16 §140 Dental Services Exclusion
1862 (a)(1)(A) Medically Reasonable & Necessary.
1862 (a)(1)(D) Investigational or Experimental.
Indications and Limitations of Coverage and/or Medical Necessity
Sleep-Disordered
Breathing, often referred to as Obstructive Sleep Apnea (OSA), is
characterized by frequent episodes of hypopnea or apnea during sleep.
Multiple detrimental physiologic changes may result from these hypopneic
and apneic episodes. Non-surgical and surgical approaches to
obstructive apnea and hypopnea have been developed.
Continuous Positive Airway Pressure (CPAP) breathing is the treatment of choice for OSA. Some patients do not tolerate CPAP, or are not benefited from it. The level of obstruction in OSA (retropalatal, retrolingual, and retropalatal and retrolingual) is variable.
Uvulopalatopharyngoplasty (UPPP) is an accepted means of surgical treatment for this disorder, but is curative in less than 50% of patients. Scientific evidence suggests that UPPP is useful in retropalatal and combination retropalatal and retrolingual obstruction.
Mandibular Maxillary Osteotomy and Advancement is a procedure developed for those patients with retrolingual obstruction, or those patients with retropalatal and retrolingual obstruction who have not responded to CPAP and uvulopalatopharyngoplasty. Medical data on the efficacy of this treatment has been reported from only a small number of centers, but the information appears to show good results for those patients who meet certain criteria. It is unknown whether the technique will result in similar results outside specialized centers.
Tracheostomy remains the surgical approach with the greatest effectiveness since it bypasses all areas of obstruction in the nasal, palatal, lingual, and pharyngeal areas. However, tracheostomy is associated with significant morbidity, and is usually reserved for patients who have failed other medical or surgical methods of treatment, or who are unsuitable for other methods of treatment for various reasons.
Various other anatomic abnormalities (such as, but not limited to, enlarged tonsils or tongue) sometimes cause OSA also. Surgical approaches to these abnormalities will vary according to the anatomic defect and the procedure/procedures needed to correct the defined problem.
Genioglossal advancement, with or without resuspension of the hyoid bone, may be performed with uvulopalatopharyngoplasty, but this procedure is not always successful, and there is little definitive information on its benefit.
A. Uvulopalatopharyngoplasty (UPPP) is covered for those patients who have all of the following:
1. Obstructive sleep apnea diagnosed (prior to any proposed surgery) in a certified sleep disorders laboratory (certification body recognized by the American Academy of Sleep Medicine);
2. A Respiratory Disturbance Index of 15 or higher
3. Failed to respond to Continuous Positive Airway Pressure therapy or cannot tolerate CPAP or other appropriate non-invasive treatment;
4. Documented counseling by a physician, with recognized training in sleep disorders, about the potential benefits and risks of the surgery; and
5. Evidence of retropalatal or combination retropalatal/retrolingual obstruction as the cause of the obstructive sleep apnea.
B. Mandibular Maxillary Osteotomy and Advancement and /or genioglossus advancement with or without hyoid suspension is covered for those patients who have all of the following:
1. Obstructive sleep apnea diagnosed (prior to any proposed surgery) in a certified sleep disorders laboratory (certification body recognized by the American Academy of Sleep Medicine);
2. A Respiratory Disturbance Index of 15 or higher;
3. Failed to respond to Continuous Positive Airway Pressure therapy or cannot tolerate CPAP or other appropriate non-invasive treatment;
4. Documented counseling by a physician, with recognized training in sleep disorders, about the potential benefits and risks of the surgery; and
5. Evidence of retrolingual obstruction as the cause of the obstructive sleep apnea, or previous failure of UPPP to correct the obstructive sleep apnea.
Regarding the Mandibular Maxillary Osteotomy and Advancement operation:
a. Separate repositioning of teeth would not be necessary except under unusual circumstances; but if necessary the dental work would be covered.
b. Application of an interdental fixation device is occasionally necessary, and is a covered service (see Documentation Requirements).
C. Tracheostomy is covered for obstructive sleep apnea that is in the judgment of the attending physician, unresponsive to other means of treatment or in cases where other means of treatment would be ineffective or not indicated.
D. When obstructive sleep apnea is caused by discrete anatomic abnormalities of the upper airway (such as, but not limited to, enlarged tonsils or an enlarged tongue), surgery to correct these abnormalities is covered if medically necessary based on adequate documentation in the medical records supporting the significant contribution of these abnormalities to OSA. Submucous radiofrequency reduction of hypertrophied turbinates is covered as an appropriate treatment for nasal obstruction due to turbinate hypertrophy that significantly contributes to OSA or significantly compromises CPAP therapy.
E. The following procedures are not covered at this time.
1. Laser-assisted uvulopalatoplasty (LAUP) is not covered at this time since it is not considered effective for OSA. LAUP must not be billed as 42145, Palatopharyngoplasty (e.g., uvulopalatopharyngoplasty, uvulopharyngoplasty). This code is not appropriate for this procedure. If LAUP is billed for denial purposes, it should be coded as 42299, (unlisted procedure, palate, uvula) with "LAUP" listed in Item 19 on the CMS-1500 claim form or equivalent field for electronic claims. The claim will then be appropriately denied as not proven effective.
2. Somnoplasty is a trade name for palate reduction with the Somnoplasty System of Somnus Medical Systems. This is not a term recognized by this Contractor as a covered procedure under Medicare Part B. Therefore Somnoplasty must not be billed as 42145. This code is not appropriate for this procedure. If Somnoplasty is billed for denial purposes, it should be coded as 42299, (unlisted procedure, palate, uvula) with "Somnoplasty" listed in Item 19 on the CMS-1500 claim form or equivalent field for electronic claims. This claim will then be appropriately denied as not proven effective.
3. The Pillar Procedure TM is a trade name for palatal implants. Palatal implants have not been shown effective for the treatment of obstructive sleep apnea and are not covered. This procedure should be billed by the physician as 42299 (unlisted procedure, palate, uvula) with "Pillar Procedure" or "palatal implant" listed in Item 19 on the CMS-1500 claim form or equivalent field for electronic claims. This claim will then be denied as not proven effective. Hospital outpatient would use code C9727.
4. Submucosal ablation of the tongue base, radiofrequency, one or more sites, per session. (41530) will be denied as investigational and experimental.
Continuous Positive Airway Pressure (CPAP) breathing is the treatment of choice for OSA. Some patients do not tolerate CPAP, or are not benefited from it. The level of obstruction in OSA (retropalatal, retrolingual, and retropalatal and retrolingual) is variable.
Uvulopalatopharyngoplasty (UPPP) is an accepted means of surgical treatment for this disorder, but is curative in less than 50% of patients. Scientific evidence suggests that UPPP is useful in retropalatal and combination retropalatal and retrolingual obstruction.
Mandibular Maxillary Osteotomy and Advancement is a procedure developed for those patients with retrolingual obstruction, or those patients with retropalatal and retrolingual obstruction who have not responded to CPAP and uvulopalatopharyngoplasty. Medical data on the efficacy of this treatment has been reported from only a small number of centers, but the information appears to show good results for those patients who meet certain criteria. It is unknown whether the technique will result in similar results outside specialized centers.
Tracheostomy remains the surgical approach with the greatest effectiveness since it bypasses all areas of obstruction in the nasal, palatal, lingual, and pharyngeal areas. However, tracheostomy is associated with significant morbidity, and is usually reserved for patients who have failed other medical or surgical methods of treatment, or who are unsuitable for other methods of treatment for various reasons.
Various other anatomic abnormalities (such as, but not limited to, enlarged tonsils or tongue) sometimes cause OSA also. Surgical approaches to these abnormalities will vary according to the anatomic defect and the procedure/procedures needed to correct the defined problem.
Genioglossal advancement, with or without resuspension of the hyoid bone, may be performed with uvulopalatopharyngoplasty, but this procedure is not always successful, and there is little definitive information on its benefit.
A. Uvulopalatopharyngoplasty (UPPP) is covered for those patients who have all of the following:
1. Obstructive sleep apnea diagnosed (prior to any proposed surgery) in a certified sleep disorders laboratory (certification body recognized by the American Academy of Sleep Medicine);
2. A Respiratory Disturbance Index of 15 or higher
3. Failed to respond to Continuous Positive Airway Pressure therapy or cannot tolerate CPAP or other appropriate non-invasive treatment;
4. Documented counseling by a physician, with recognized training in sleep disorders, about the potential benefits and risks of the surgery; and
5. Evidence of retropalatal or combination retropalatal/retrolingual obstruction as the cause of the obstructive sleep apnea.
B. Mandibular Maxillary Osteotomy and Advancement and /or genioglossus advancement with or without hyoid suspension is covered for those patients who have all of the following:
1. Obstructive sleep apnea diagnosed (prior to any proposed surgery) in a certified sleep disorders laboratory (certification body recognized by the American Academy of Sleep Medicine);
2. A Respiratory Disturbance Index of 15 or higher;
3. Failed to respond to Continuous Positive Airway Pressure therapy or cannot tolerate CPAP or other appropriate non-invasive treatment;
4. Documented counseling by a physician, with recognized training in sleep disorders, about the potential benefits and risks of the surgery; and
5. Evidence of retrolingual obstruction as the cause of the obstructive sleep apnea, or previous failure of UPPP to correct the obstructive sleep apnea.
Regarding the Mandibular Maxillary Osteotomy and Advancement operation:
a. Separate repositioning of teeth would not be necessary except under unusual circumstances; but if necessary the dental work would be covered.
b. Application of an interdental fixation device is occasionally necessary, and is a covered service (see Documentation Requirements).
C. Tracheostomy is covered for obstructive sleep apnea that is in the judgment of the attending physician, unresponsive to other means of treatment or in cases where other means of treatment would be ineffective or not indicated.
D. When obstructive sleep apnea is caused by discrete anatomic abnormalities of the upper airway (such as, but not limited to, enlarged tonsils or an enlarged tongue), surgery to correct these abnormalities is covered if medically necessary based on adequate documentation in the medical records supporting the significant contribution of these abnormalities to OSA. Submucous radiofrequency reduction of hypertrophied turbinates is covered as an appropriate treatment for nasal obstruction due to turbinate hypertrophy that significantly contributes to OSA or significantly compromises CPAP therapy.
E. The following procedures are not covered at this time.
1. Laser-assisted uvulopalatoplasty (LAUP) is not covered at this time since it is not considered effective for OSA. LAUP must not be billed as 42145, Palatopharyngoplasty (e.g., uvulopalatopharyngoplasty, uvulopharyngoplasty). This code is not appropriate for this procedure. If LAUP is billed for denial purposes, it should be coded as 42299, (unlisted procedure, palate, uvula) with "LAUP" listed in Item 19 on the CMS-1500 claim form or equivalent field for electronic claims. The claim will then be appropriately denied as not proven effective.
2. Somnoplasty is a trade name for palate reduction with the Somnoplasty System of Somnus Medical Systems. This is not a term recognized by this Contractor as a covered procedure under Medicare Part B. Therefore Somnoplasty must not be billed as 42145. This code is not appropriate for this procedure. If Somnoplasty is billed for denial purposes, it should be coded as 42299, (unlisted procedure, palate, uvula) with "Somnoplasty" listed in Item 19 on the CMS-1500 claim form or equivalent field for electronic claims. This claim will then be appropriately denied as not proven effective.
3. The Pillar Procedure TM is a trade name for palatal implants. Palatal implants have not been shown effective for the treatment of obstructive sleep apnea and are not covered. This procedure should be billed by the physician as 42299 (unlisted procedure, palate, uvula) with "Pillar Procedure" or "palatal implant" listed in Item 19 on the CMS-1500 claim form or equivalent field for electronic claims. This claim will then be denied as not proven effective. Hospital outpatient would use code C9727.
4. Submucosal ablation of the tongue base, radiofrequency, one or more sites, per session. (41530) will be denied as investigational and experimental.
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.
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.
| 21110 | APPLICATION OF INTERDENTAL FIXATION DEVICE FOR CONDITIONS OTHER THAN FRACTURE OR DISLOCATION, INCLUDES REMOVAL |
| 21141 | RECONSTRUCTION MIDFACE, LEFORT I; SINGLE PIECE, SEGMENT MOVEMENT IN ANY DIRECTION (EG, FOR LONG FACE SYNDROME), WITHOUT BONE GRAFT |
| 21145 | RECONSTRUCTION MIDFACE, LEFORT I; SINGLE PIECE, SEGMENT MOVEMENT IN ANY DIRECTION, REQUIRING BONE GRAFTS (INCLUDES OBTAINING AUTOGRAFTS) |
| 21196 | RECONSTRUCTION OF MANDIBULAR RAMI AND/OR BODY, SAGITTAL SPLIT; WITH INTERNAL RIGID FIXATION |
| 21199 | OSTEOTOMY, MANDIBLE, SEGMENTAL; WITH GENIOGLOSSUS ADVANCEMENT |
| 21685 | HYOID MYOTOMY AND SUSPENSION |
| 30140 | SUBMUCOUS RESECTION INFERIOR TURBINATE, PARTIAL OR COMPLETE, ANY METHOD |
| 30802 | ABLATION, SOFT TISSUE OF INFERIOR TURBINATES, UNILATERAL OR BILATERAL, ANY METHOD (EG, ELECTROCAUTERY, RADIOFREQUENCY ABLATION, OR TISSUE VOLUME REDUCTION); INTRAMURAL (IE, SUBMUCOSAL) |
| 31600 | TRACHEOSTOMY, PLANNED (SEPARATE PROCEDURE); |
| 31610 | TRACHEOSTOMY, FENESTRATION PROCEDURE WITH SKIN FLAPS |
| 41512 | TONGUE BASE SUSPENSION, PERMANENT SUTURE TECHNIQUE |
| 41530 | SUBMUCOSAL ABLATION OF THE TONGUE BASE, RADIOFREQUENCY, 1 OR MORE SITES, PER SESSION |
| 42145 | PALATOPHARYNGOPLASTY (EG, UVULOPALATOPHARYNGOPLASTY, UVULOPHARYNGOPLASTY) |
| 42299 | UNLISTED PROCEDURE, PALATE, UVULA |
| C9727 | INSERTION OF IMPLANTS INTO THE SOFT PALATE; MINIMUM OF THREE IMPLANTS |
ICD-9 Codes that Support Medical Necessity
These are the only covered diagnoses for CPT codes 21685, and 42145. This list will not address the other listed HCPCS services/procedures.
| 327.23 | OBSTRUCTIVE SLEEP APNEA (ADULT) (PEDIATRIC) |
| 780.51 | INSOMNIA WITH SLEEP APNEA, UNSPECIFIED |
| 780.53 | HYPERSOMNIA WITH SLEEP APNEA, UNSPECIFIED |
| 780.57 | UNSPECIFIED SLEEP APNEA |
*Both the primary ICD-9-CM code 327.23 (Obstructive sleep apnea) and at least one of the following secondary codes (529.8 or 750.15) must be present on the claim.
Primary diagnosis code for CPT codes 41512:
| 327.23 | OBSTRUCTIVE SLEEP APNEA (ADULT) (PEDIATRIC) |
Note that ICD-9-CM code 529.8 may be used only for tongue hypertrophy. Each of the conditions must be documented in the medical record which must be made available to Medicare on request.
| 529.8 | OTHER SPECIFIED CONDITIONS OF THE TONGUE |
| 750.15 | MACROGLOSSIA |
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
Physicians' Services
and diagnostic tests/x-rays must be submitted with an ICD-9 code to
support medical necessity and must be coded to the greatest level of
specificity and the highest level of digit completeness. The precise
ICD-9 code that most fully explains the narrative diagnosis contained in
the medical record or test interpretation/report including the 4th or
5th digit sub-classification for the diagnosis category is expected. The
ICD-9 code based on the results of the test should be the primary
diagnosis. If the test results are normal or inconclusive the ICD-9 code
representing the sign, symptom, illness or injury prompting the
ordering of the test/x-ray should be reported as the primary diagnosis.
In the absence of signs, symptoms, illness or injury, a screening ICD-9
code should be reported, and payment will be denied.
The patient's medical records must be legible, contain the relevant history, and physical findings conforming to the criteria listed under the "Indications and Limitations of Coverage and/or Medical Necessity" section, and must be made available to the contractor upon request.
Documentation of the counseling of the risks and benefits of the procedure must be included in the patient's medical records and must be made available to the Contractor on request.
Documentation of adequate trial of CPAP or other modes of continuous positive airway pressure therapy for obstructive sleep apnea under the care of a physician specifically trained in sleep disordered breathing must also be included in the patient's medical record and must be made available to the Contractor on request. Absence of this information could result in denial.
After adequate healing of the surgical site, follow-up evaluation by a physician with recognized training in sleep disorders is recommended and shall be documented accordingly.
Appendices
The patient's medical records must be legible, contain the relevant history, and physical findings conforming to the criteria listed under the "Indications and Limitations of Coverage and/or Medical Necessity" section, and must be made available to the contractor upon request.
Documentation of the counseling of the risks and benefits of the procedure must be included in the patient's medical records and must be made available to the Contractor on request.
Documentation of adequate trial of CPAP or other modes of continuous positive airway pressure therapy for obstructive sleep apnea under the care of a physician specifically trained in sleep disordered breathing must also be included in the patient's medical record and must be made available to the Contractor on request. Absence of this information could result in denial.
After adequate healing of the surgical site, follow-up evaluation by a physician with recognized training in sleep disorders is recommended and shall be documented accordingly.
*- An asterisk indicates a revision to that section of the policy.
This policy does not reflect the sole opinion of the contractor or Contractor Medical Director. Although the final decision rests with the MAC contractor this policy was developed in cooperation with advisory groups which include representatives from various specialties, and adapted for the purpose of converting to MAC jurisdiction.
Sources of Information and Basis for Decision
This policy does not reflect the sole opinion of the contractor or Contractor Medical Director. Although the final decision rests with the MAC contractor this policy was developed in cooperation with advisory groups which include representatives from various specialties, and adapted for the purpose of converting to MAC jurisdiction.
Davila, D. G., 1995,
"Medical Considerations in Surgery for Sleep Apnea", Oral and
Maxillofacial Surgery Clinics of North America, 7: 205-221.
Finkelstein, Y., et al, 1997 Uvulopalatopharyngoplasty Vs Laser-Assisted Uvulopalatoplasty, Arch Otolaryngol, Head Neck Surgery, Vol. 123, March 1997 pg. 265-276.
Riley, R.W., et al, 1993, "Obstructive Sleep Apnea Syndrome: A Review of 306 Consecutively Treated Surgical Patients", Otolaryngol Head Neck Surg, 108: 117-125.
Sher, A.E., et al, 1996, "The Efficacy of Surgical Modifications of the Upper Airway in Adults with Obstructive Sleep Apnea Syndrome", Sleep, 19: 156-177.
Standards of Practice Committee of the American Sleep Disorders Association, "Practice Parameters for the Treatment of Obstructive Sleep Apnea in Adults: the Efficacy of Surgical Modifications of the Upper Airway", Sleep, 1996; 19: 152-155.
Strollo, P.J., and Rogers, R.M., 1994, "Obstructive Sleep Apnea", New Engl J. Med., 334: 99-104.
National Institues of Health, National Heart, Lung, and Blood Institue: Treatment of Sleep Disorders
(1997)
Carrier Medical Directors' New Technology Work Group.
Consultants in Otolaryngology and Oro-Mandibular Surgery.
Standards of Practice Committee, American Academy of Sleep Medicine, "Practice Parameters for the Use of Laser-Assisted Uvulopalatoplasty: An Update for 2000", Sleep, 24: 603-619.
Friedman M. et al, 2006, "Patient Selection and Efficacy of Pillar Implant Technique for the Treatment of Snoring and Obstructive Sleep Apnea/Hypopnea Syndrome", Otolaryngol Head and Neck Surg.2006 Feb;134(2):187-196
Nordgard S. et al, 2006 "Soft Palate Implants for the Treatment of Mild to Moderate Obstructive Sleep Apnea", Otolaryngol Head and Neck Surg.2006 Apr;134(4):565-570
Advisory Committee Meeting Notes
Finkelstein, Y., et al, 1997 Uvulopalatopharyngoplasty Vs Laser-Assisted Uvulopalatoplasty, Arch Otolaryngol, Head Neck Surgery, Vol. 123, March 1997 pg. 265-276.
Riley, R.W., et al, 1993, "Obstructive Sleep Apnea Syndrome: A Review of 306 Consecutively Treated Surgical Patients", Otolaryngol Head Neck Surg, 108: 117-125.
Sher, A.E., et al, 1996, "The Efficacy of Surgical Modifications of the Upper Airway in Adults with Obstructive Sleep Apnea Syndrome", Sleep, 19: 156-177.
Standards of Practice Committee of the American Sleep Disorders Association, "Practice Parameters for the Treatment of Obstructive Sleep Apnea in Adults: the Efficacy of Surgical Modifications of the Upper Airway", Sleep, 1996; 19: 152-155.
Strollo, P.J., and Rogers, R.M., 1994, "Obstructive Sleep Apnea", New Engl J. Med., 334: 99-104.
National Institues of Health, National Heart, Lung, and Blood Institue: Treatment of Sleep Disorders
(1997)
Carrier Medical Directors' New Technology Work Group.
Consultants in Otolaryngology and Oro-Mandibular Surgery.
Standards of Practice Committee, American Academy of Sleep Medicine, "Practice Parameters for the Use of Laser-Assisted Uvulopalatoplasty: An Update for 2000", Sleep, 24: 603-619.
Friedman M. et al, 2006, "Patient Selection and Efficacy of Pillar Implant Technique for the Treatment of Snoring and Obstructive Sleep Apnea/Hypopnea Syndrome", Otolaryngol Head and Neck Surg.2006 Feb;134(2):187-196
Nordgard S. et al, 2006 "Soft Palate Implants for the Treatment of Mild to Moderate Obstructive Sleep Apnea", Otolaryngol Head and Neck Surg.2006 Apr;134(4):565-570
Advisory Committee Meeting Notes
Meeting Date:
Wisconsin: 2/12/2010
Illinois: 1/13/2010
Michigan: 1/27/2010
Minnesota: 1/14/2010
J-5 MAC
(IA,KS, MO, NE) 2/19/2010
Open LCD meeting
01/06/2010
Start Date of Comment Period
Meeting Date:
Wisconsin: 2/12/2010
Illinois: 1/13/2010
Michigan: 1/27/2010
Minnesota: 1/14/2010
J-5 MAC
(IA,KS, MO, NE) 2/19/2010
Open LCD meeting
01/06/2010
02/19/2010
End Date of Comment Period
04/05/2010
Start Date of Notice Period
06/01/2010
Revision History Number
X
Revision History Explanation
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:
21141 descriptor was changed in Group 1
21145 descriptor was changed in Group 1
42145 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).
04/01/2011-Annual review, no change to coverage
11/01/2011- Article published. Clarification-added investigational and experimental to explain the reason we were not covering CPT 41530
Reason for Change
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:
21141 descriptor was changed in Group 1
21145 descriptor was changed in Group 1
42145 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).
04/01/2011-Annual review, no change to coverage
11/01/2011- Article published. Clarification-added investigational and experimental to explain the reason we were not covering CPT 41530
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