Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring) (L29584)
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
L29584 LCD Title Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring) Contractor's Determination Number CV-016 AMA CPT/ADA CDT Copyright Statement CPT only copyright 2002-2011 American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. The Code on Dental Procedures and Nomenclature (Code) is published in Current Dental Terminology (CDT). Copyright © American Dental Association. All rights reserved. CDT and CDT-2010 are trademarks of the American Dental Association. |
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 05/01/2012 Revision Ending Date |
CMS National Coverage Policy
CMS Pub. 100-3, Ch. 1- §20.15
Indications and Limitations of Coverage and/or Medical Necessity
Long-Term
ECG Monitoring is defined as a diagnostic procedure, which can provide
continuous recording capabilities of ECG activities of the patient's
heart while the patient is engaged in daily activities. These can
include continuous, patient-demand or *auto-detection devices. The
purpose of these tests is to provide information about rhythm
disturbances and waveform abnormalities and to note the frequency of
their occurrence.
Definitions:
Cardiac Event Detection (CED) is a 30-day service for the purpose of documentation and diagnosis of paroxysmal or suspected arrhythmias.
Holter Monitoring (24-hour ECG monitoring) is a study used to evaluate the patient's ambient heart rhythm during a full day's (24 Hours) cycle. It is a wearable EKG monitor that records the overall rhythm and significant arrhythmias.
A. Medical Necessity:
The medical necessity indications listed in this policy must be present in order for these tests to be covered.
B. Indications for external 48-hour ECG recording (CPT/HCPCS codes 93224-93227) include one or more of the following
1. Symptoms:
a. Arrhythmias (ICD-9 codes 426.0-426.9, 427.0-427.42, 427.60-427.9)
b. Chest pain (ICD-9 codes 411.1, 786.50, 786.51, 786.59)
c. Syncope (lightheadedness) or near syncope (ICD-9 code 780.2)
d. Vertigo (dizziness) (ICD-9 code 780.4)
e. Palpitations (ICD-9 code 785.1)
f. Transient ischemic episodes (ICD-9 codes 780.02, 781.0, 781.4)
g. Dyspnea (shortness of breath) (ICD-9 codes 786.00-786.09)
2. Evaluation of the response to antiarrhythmic drug therapy (ICD-9 codes V58.69).
3. Evaluation of myocardial infarction (MI) survivors with an ejection fraction of 40% or less. (ICD-9 codes 410.00-410.92, 411.0, and 412).
4. Assessment of patients with coronary artery disease with active symptoms, to correlate chest pain with ST-segment changes (ICD-9 codes 413.0-413.9).
5. Other acute and subacute forms of ischemic heart disease. (411.0-411.89).
6. To detect arrhythmias post ablation procedures.
C. The use of 0295T, 0296T, 0297T and 0298T, external electrocardiographic recording for more than 48 hours up to 21 days by continuous rhythm recording and storage, may be considered medically necessary in patients treated for reasons listed in the ICD-9-CM list to monitor for asymptomatic episodes in order to evaluate treatment response, The use of external electrocardiographic event monitors for more than 48 hours up to 21 days that are either patient-activated or auto-activated may be considered medically necessary as a diagnostic alternative to Holter monitoring in patients who experience infrequent symptoms (less frequently than every 48 hours) suggestive of cardiac arrhythmias (i.e., palpitations, dizziness, presyncope, or syncope).
D. Long term 30-day monitoring; Telephonic Transmission of ECG (CPT codes 93228, 93229, and 93268-93272) involve 24 hour attended monitoring per 30 day period of time; no other EKG monitoring codes can be billed simultaneously with these codes.
Indications for performing a Telephonic Transmission:
a. Arrhythmias (ICD-9 codes 426.0-426.9, 427.0-427.42, 427.60-427.9);
b. Chest pain (ICD-9 codes 411.1, 786.50, 786.51, 786.59);
c. Syncope (lightheadedness) or near syncope (ICD-9 code 780.2);
d. Vertigo (dizziness) (ICD-9 code 780.4);
e. Palpitations (ICD-9 code 785.1);
f. Transient ischemic episodes (ICD-9 codes 780.02, 781.0, 781.4);
g. Dyspnea (shortness of breath) (ICD-9 codes 786.00-786.09).
h. To initiate, revise or discontinue arrhythmia drug therapy. (V58.69)
i. Evaluation of myocardial infarction (MI) survivors. (ICD-9 codes 410.00-410.92, 411.0, and 412).
j. Evaluation of acute and subacute forms of ischemic heart disease. (411.0-411.89).
k. Assessment of patients with coronary artery disease with active symptoms, to correlate chest pain with ST-segment changes (ICD-9 codes 413.0-413.9).
Bill type codes only apply to providers who bill these services to the fiscal intermediary or Part A MAC. Bill type codes do not apply to physicians, other professionals and suppliers who bill these services to the carrier or Part B MAC.
Definitions:
Cardiac Event Detection (CED) is a 30-day service for the purpose of documentation and diagnosis of paroxysmal or suspected arrhythmias.
Holter Monitoring (24-hour ECG monitoring) is a study used to evaluate the patient's ambient heart rhythm during a full day's (24 Hours) cycle. It is a wearable EKG monitor that records the overall rhythm and significant arrhythmias.
A. Medical Necessity:
The medical necessity indications listed in this policy must be present in order for these tests to be covered.
B. Indications for external 48-hour ECG recording (CPT/HCPCS codes 93224-93227) include one or more of the following
1. Symptoms:
a. Arrhythmias (ICD-9 codes 426.0-426.9, 427.0-427.42, 427.60-427.9)
b. Chest pain (ICD-9 codes 411.1, 786.50, 786.51, 786.59)
c. Syncope (lightheadedness) or near syncope (ICD-9 code 780.2)
d. Vertigo (dizziness) (ICD-9 code 780.4)
e. Palpitations (ICD-9 code 785.1)
f. Transient ischemic episodes (ICD-9 codes 780.02, 781.0, 781.4)
g. Dyspnea (shortness of breath) (ICD-9 codes 786.00-786.09)
2. Evaluation of the response to antiarrhythmic drug therapy (ICD-9 codes V58.69).
3. Evaluation of myocardial infarction (MI) survivors with an ejection fraction of 40% or less. (ICD-9 codes 410.00-410.92, 411.0, and 412).
4. Assessment of patients with coronary artery disease with active symptoms, to correlate chest pain with ST-segment changes (ICD-9 codes 413.0-413.9).
5. Other acute and subacute forms of ischemic heart disease. (411.0-411.89).
6. To detect arrhythmias post ablation procedures.
C. The use of 0295T, 0296T, 0297T and 0298T, external electrocardiographic recording for more than 48 hours up to 21 days by continuous rhythm recording and storage, may be considered medically necessary in patients treated for reasons listed in the ICD-9-CM list to monitor for asymptomatic episodes in order to evaluate treatment response, The use of external electrocardiographic event monitors for more than 48 hours up to 21 days that are either patient-activated or auto-activated may be considered medically necessary as a diagnostic alternative to Holter monitoring in patients who experience infrequent symptoms (less frequently than every 48 hours) suggestive of cardiac arrhythmias (i.e., palpitations, dizziness, presyncope, or syncope).
D. Long term 30-day monitoring; Telephonic Transmission of ECG (CPT codes 93228, 93229, and 93268-93272) involve 24 hour attended monitoring per 30 day period of time; no other EKG monitoring codes can be billed simultaneously with these codes.
Indications for performing a Telephonic Transmission:
a. Arrhythmias (ICD-9 codes 426.0-426.9, 427.0-427.42, 427.60-427.9);
b. Chest pain (ICD-9 codes 411.1, 786.50, 786.51, 786.59);
c. Syncope (lightheadedness) or near syncope (ICD-9 code 780.2);
d. Vertigo (dizziness) (ICD-9 code 780.4);
e. Palpitations (ICD-9 code 785.1);
f. Transient ischemic episodes (ICD-9 codes 780.02, 781.0, 781.4);
g. Dyspnea (shortness of breath) (ICD-9 codes 786.00-786.09).
h. To initiate, revise or discontinue arrhythmia drug therapy. (V58.69)
i. Evaluation of myocardial infarction (MI) survivors. (ICD-9 codes 410.00-410.92, 411.0, and 412).
j. Evaluation of acute and subacute forms of ischemic heart disease. (411.0-411.89).
k. Assessment of patients with coronary artery disease with active symptoms, to correlate chest pain with ST-segment changes (ICD-9 codes 413.0-413.9).
Bill type codes only apply to providers who bill these services to the fiscal intermediary or Part A MAC. Bill type codes do not apply to physicians, other professionals and suppliers who bill these services to the carrier or Part B MAC.
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.
| 013x | Hospital Outpatient |
| 085x | Critical Access Hospital |
Revenue Codes:
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.
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 codes only apply to providers who bill these services to the fiscal intermediary or Part A MAC. Revenue codes do not apply to physicians, other professionals and suppliers who bill these services to the carrier or Part B MAC.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.
| 0489 | Cardiology - Other Cardiology |
| 073X | EKG/ECG (Electrocardiogram) - General Classification |
Memory Loop Recordings
| 93268 | EXTERNAL PATIENT AND, WHEN PERFORMED, AUTO ACTIVATED ELECTROCARDIOGRAPHIC RHYTHM DERIVED EVENT RECORDING WITH SYMPTOM-RELATED MEMORY LOOP WITH REMOTE DOWNLOAD CAPABILITY UP TO 30 DAYS, 24-HOUR ATTENDED MONITORING; INCLUDES TRANSMISSION, PHYSICIAN REVIEW AND INTERPRETATION |
| 93270 | EXTERNAL PATIENT AND, WHEN PERFORMED, AUTO ACTIVATED ELECTROCARDIOGRAPHIC RHYTHM DERIVED EVENT RECORDING WITH SYMPTOM-RELATED MEMORY LOOP WITH REMOTE DOWNLOAD CAPABILITY UP TO 30 DAYS, 24-HOUR ATTENDED MONITORING; RECORDING (INCLUDES CONNECTION, RECORDING, AND DISCONNECTION) |
| 93271 | EXTERNAL PATIENT AND, WHEN PERFORMED, AUTO ACTIVATED ELECTROCARDIOGRAPHIC RHYTHM DERIVED EVENT RECORDING WITH SYMPTOM-RELATED MEMORY LOOP WITH REMOTE DOWNLOAD CAPABILITY UP TO 30 DAYS, 24-HOUR ATTENDED MONITORING; TRANSMISSION AND ANALYSIS |
| 93272 | EXTERNAL PATIENT AND, WHEN PERFORMED, AUTO ACTIVATED ELECTROCARDIOGRAPHIC RHYTHM DERIVED EVENT RECORDING WITH SYMPTOM-RELATED MEMORY LOOP WITH REMOTE DOWNLOAD CAPABILITY UP TO 30 DAYS, 24-HOUR ATTENDED MONITORING; PHYSICIAN REVIEW AND INTERPRETATION |
Other up to 48-Hour Recordings
| 93224 | EXTERNAL ELECTROCARDIOGRAPHIC RECORDING UP TO 48 HOURS BY CONTINUOUS RHYTHM RECORDING AND STORAGE; INCLUDES RECORDING, SCANNING ANALYSIS WITH REPORT, PHYSICIAN REVIEW AND INTERPRETATION |
| 93225 | EXTERNAL ELECTROCARDIOGRAPHIC RECORDING UP TO 48 HOURS BY CONTINUOUS RHYTHM RECORDING AND STORAGE; RECORDING (INCLUDES CONNECTION, RECORDING, AND DISCONNECTION) |
| 93226 | EXTERNAL ELECTROCARDIOGRAPHIC RECORDING UP TO 48 HOURS BY CONTINUOUS RHYTHM RECORDING AND STORAGE; SCANNING ANALYSIS WITH REPORT |
| 93227 | EXTERNAL ELECTROCARDIOGRAPHIC RECORDING UP TO 48 HOURS BY CONTINUOUS RHYTHM RECORDING AND STORAGE; PHYSICIAN REVIEW AND INTERPRETATION |
| 93228 | EXTERNAL MOBILE CARDIOVASCULAR TELEMETRY WITH ELECTROCARDIOGRAPHIC RECORDING, CONCURRENT COMPUTERIZED REAL TIME DATA ANALYSIS AND GREATER THAN 24 HOURS OF ACCESSIBLE ECG DATA STORAGE (RETRIEVABLE WITH QUERY) WITH ECG TRIGGERED AND PATIENT SELECTED EVENTS TRANSMITTED TO A REMOTE ATTENDED SURVEILLANCE CENTER FOR UP TO 30 DAYS; PHYSICIAN REVIEW AND INTERPRETATION WITH REPORT |
| 93229 | EXTERNAL MOBILE CARDIOVASCULAR TELEMETRY WITH ELECTROCARDIOGRAPHIC RECORDING, CONCURRENT COMPUTERIZED REAL TIME DATA ANALYSIS AND GREATER THAN 24 HOURS OF ACCESSIBLE ECG DATA STORAGE (RETRIEVABLE WITH QUERY) WITH ECG TRIGGERED AND PATIENT SELECTED EVENTS TRANSMITTED TO A REMOTE ATTENDED SURVEILLANCE CENTER FOR UP TO 30 DAYS; TECHNICAL SUPPORT FOR CONNECTION AND PATIENT INSTRUCTIONS FOR USE, ATTENDED SURVEILLANCE, ANALYSIS AND PHYSICIAN PRESCRIBED TRANSMISSION OF DAILY AND EMERGENT DATA REPORTS |
External electrocardiographic recording for more than 48 hours up to 21 days.
The CPT/HCPCS file states "Do not report 0295T-0298T in conjunction with 93224-93272 for same monitoring period".
The
use of auto-activated external electrocardiographic event recordings
may be considered medically necessary in the outpatient setting and are
non- covered for inpatient or outpatient observation care.
Documentation supporting medical necessity may be requested
| 0295T | EXTERNAL ELECTROCARDIOGRAPHIC RECORDING FOR MORE THAN 48 HOURS UP TO 21 DAYS BY CONTINUOUS RHYTHM RECORDING AND STORAGE; INCLUDES RECORDING, SCANNING ANALYSIS WITH REPORT, REVIEW AND INTERPRETATION |
| 0296T | EXTERNAL ELECTROCARDIOGRAPHIC RECORDING FOR MORE THAN 48 HOURS UP TO 21 DAYS BY CONTINUOUS RHYTHM RECORDING AND STORAGE; RECORDING (INCLUDES CONNECTION AND INITIAL RECORDING) |
| 0297T | EXTERNAL ELECTROCARDIOGRAPHIC RECORDING FOR MORE THAN 48 HOURS UP TO 21 DAYS BY CONTINUOUS RHYTHM RECORDING AND STORAGE; SCANNING ANALYSIS WITH REPORT |
| 0298T | EXTERNAL ELECTROCARDIOGRAPHIC RECORDING FOR MORE THAN 48 HOURS UP TO 21 DAYS BY CONTINUOUS RHYTHM RECORDING AND STORAGE; REVIEW AND INTERPRETATION |
ICD-9 Codes that Support Medical Necessity
| 410.00 - 410.92 | ACUTE MYOCARDIAL INFARCTION OF ANTEROLATERAL WALL EPISODE OF CARE UNSPECIFIED - ACUTE MYOCARDIAL INFARCTION OF UNSPECIFIED SITE SUBSEQUENT EPISODE OF CARE |
| 411.0 - 411.89 | POSTMYOCARDIAL INFARCTION SYNDROME - OTHER ACUTE AND SUBACUTE FORMS OF ISCHEMIC HEART DISEASE OTHER |
| 412 | OLD MYOCARDIAL INFARCTION |
| 413.0 - 413.9 | ANGINA DECUBITUS - OTHER AND UNSPECIFIED ANGINA PECTORIS |
| 426.0 - 426.9 | ATRIOVENTRICULAR BLOCK COMPLETE - CONDUCTION DISORDER UNSPECIFIED |
| 427.0 - 427.42 | PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA - VENTRICULAR FLUTTER |
| 427.60 - 427.9 | PREMATURE BEATS UNSPECIFIED - CARDIAC DYSRHYTHMIA UNSPECIFIED |
| 780.02 | TRANSIENT ALTERATION OF AWARENESS |
| 780.2 | SYNCOPE AND COLLAPSE |
| 780.4 | DIZZINESS AND GIDDINESS |
| 781.0 | ABNORMAL INVOLUNTARY MOVEMENTS |
| 781.4 | TRANSIENT PARALYSIS OF LIMB |
| 785.1 | PALPITATIONS |
| 786.00 - 786.09 | RESPIRATORY ABNORMALITY UNSPECIFIED - RESPIRATORY ABNORMALITY OTHER |
| 786.50 | UNSPECIFIED CHEST PAIN |
| 786.51 | PRECORDIAL PAIN |
| 786.59 | OTHER CHEST PAIN |
| V58.69 | LONG-TERM (CURRENT) USE OF OTHER MEDICATIONS |
Diagnoses that Support Medical Necessity
Diagnoses listed above
ICD-9 Codes that DO NOT Support Medical Necessity
ICD-9 codes not listed above
ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation
Diagnoses that DO NOT Support Medical Necessity
Diagnoses not listed above
General Information
Medicare Part B
monitors for medical necessity, which can include frequency.
Documentation would include a history and physical exam. The record
should document the evaluation, which focuses on the cause(s) of the
presenting symptoms and/or the need for this testing. Some examples
are:
1. The patient record has an evaluation and management service that documents the symptoms experienced by the patient.
2. The patient has had a full workup in the past month with initial tests performed, and presents with continuing symptoms that indicate the need for up to 48 hour monitoring or long-term monitoring;
3. The patient requires a change in antiarrhythmic medication. In this case, an assessment of the patient's complaints, the name of the medication stopped and the name of the new medication should be indicated.
4. In the case of referred tests, documentation of medical necessity may be requested from the referring physician. These are considered purchased diagnostic tests.
5. Independent diagnostic testing facilities (IDTF) and suppliers must retain records that include:
a. The referring physician's written orders; and
b. The identity of the employee setting up the tracing.
Documentation should be submitted as indicated when requested or when unusual circumstances are present. The EMC narrative may be used.
1. The patient record has an evaluation and management service that documents the symptoms experienced by the patient.
2. The patient has had a full workup in the past month with initial tests performed, and presents with continuing symptoms that indicate the need for up to 48 hour monitoring or long-term monitoring;
3. The patient requires a change in antiarrhythmic medication. In this case, an assessment of the patient's complaints, the name of the medication stopped and the name of the new medication should be indicated.
4. In the case of referred tests, documentation of medical necessity may be requested from the referring physician. These are considered purchased diagnostic tests.
5. Independent diagnostic testing facilities (IDTF) and suppliers must retain records that include:
a. The referring physician's written orders; and
b. The identity of the employee setting up the tracing.
Documentation should be submitted as indicated when requested or when unusual circumstances are present. The EMC narrative may be used.
Appendices
Utilization Guidelines
N/A
Sources of Information and Basis for Decision
Pub 100-3, Ch 1- §20.15
Final Rule, Federal Register, Dec. 31, 2002
Other Medical Carriers
Final Rule, Federal Register, Dec. 31, 2002
Other Medical Carriers
Advisory Committee Meeting Notes
This LCD consolidates and replaces all previous policies and publications on this subject by the carrier and fiscal intermediary predecessors of Wisconsin Physicians Service. This coverage determination also applies within states outside the primary geographic jurisdiction that have nominated Wisconsin Physicians Service to process their claims.
Meeting Date
Wisconsin 01/16/2009
Illinois 01/28/2009
Michigan 01/07/2009
Minnesota 01/22/2009
Iowa, Kansas, Missouri, Nebraska 02/12/2009
Any Carrier Advisory Committee (CAC) related information, including Start date and End Date of Comment Period, reflects the last time this LCD passed through the Comment and Notice process.
Meeting Date
Wisconsin 01/16/2009
Illinois 01/28/2009
Michigan 01/07/2009
Minnesota 01/22/2009
Iowa, Kansas, Missouri, Nebraska 02/12/2009
Any Carrier Advisory Committee (CAC) related information, including Start date and End Date of Comment Period, reflects the last time this LCD passed through the Comment and Notice process.
Start Date of Comment Period
02/12/2009
End Date of Comment Period
03/30/2009
Start Date of Notice Period
09/01/2009
Revision History Number
X
Revision History Explanation
09/02/2009 No change to coverage.
06/30/2009 The contractor number 05392 will no longer be valid as of 8/1/2009 as it will be joining with the W MO number.
Revision to draft 6/30/2009
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 13 was changed
8/1/2010 - The description for Bill Type Code 85 was changed
8/1/2010 - The description for Revenue code 0489 was changed
8/1/2010 - The description for Revenue code 0730 was changed
8/1/2010 - The description for Revenue code 0731 was changed
8/1/2010 - The description for Revenue code 0732 was changed
8/1/2010 - The description for Revenue code 0739 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:
93268 descriptor was changed in Group 2
93270 descriptor was changed in Group 2
93271 descriptor was changed in Group 2
93272 descriptor was changed in Group 2
93224 descriptor was changed in Group 3
93225 descriptor was changed in Group 3
93226 descriptor was changed in Group 3
93227 descriptor was changed in Group 3
93228 descriptor was changed in Group 3
93229 descriptor was changed in Group 3
11/21/2010 - The following CPT/HCPCS codes were deleted:
93012 was deleted from Group 1
93014 was deleted from Group 1
93230 was deleted from Group 3
93231 was deleted from Group 3
93232 was deleted from Group 3
93233 was deleted from Group 3
93235 was deleted from Group 3
93236 was deleted from Group 3
93237 was deleted from Group 3
*01/01/2011, CPT 2011 revisions; Discontinued CPT codes 93012, 93014, 93230, 93231, 93232, 93233, 93235, 93236, and 93237. CPT long description changes CPT codes 93224, 93225, 93226, 93227, 93228, 93229, 93268, 93270, 93271, and 93272. Deleted under Indications and Limitations paragraph C. Effective 01/01/2011 (one).
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. Reformatted. No coverage changes (two).
11/21/2011 - 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:
93271 descriptor was changed in Group 1
05/01/2012: Addition of CPT codes 0295T, 0296T, 0297T and 0298T, effective 01/01/2012. Inclusion of Category III codes as payable when medically necessary and conditions of coverage have been met expands coverage. Thus no notice period applies. (three)
06/30/2009 The contractor number 05392 will no longer be valid as of 8/1/2009 as it will be joining with the W MO number.
Revision to draft 6/30/2009
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 13 was changed
8/1/2010 - The description for Bill Type Code 85 was changed
8/1/2010 - The description for Revenue code 0489 was changed
8/1/2010 - The description for Revenue code 0730 was changed
8/1/2010 - The description for Revenue code 0731 was changed
8/1/2010 - The description for Revenue code 0732 was changed
8/1/2010 - The description for Revenue code 0739 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:
93268 descriptor was changed in Group 2
93270 descriptor was changed in Group 2
93271 descriptor was changed in Group 2
93272 descriptor was changed in Group 2
93224 descriptor was changed in Group 3
93225 descriptor was changed in Group 3
93226 descriptor was changed in Group 3
93227 descriptor was changed in Group 3
93228 descriptor was changed in Group 3
93229 descriptor was changed in Group 3
11/21/2010 - The following CPT/HCPCS codes were deleted:
93012 was deleted from Group 1
93014 was deleted from Group 1
93230 was deleted from Group 3
93231 was deleted from Group 3
93232 was deleted from Group 3
93233 was deleted from Group 3
93235 was deleted from Group 3
93236 was deleted from Group 3
93237 was deleted from Group 3
*01/01/2011, CPT 2011 revisions; Discontinued CPT codes 93012, 93014, 93230, 93231, 93232, 93233, 93235, 93236, and 93237. CPT long description changes CPT codes 93224, 93225, 93226, 93227, 93228, 93229, 93268, 93270, 93271, and 93272. Deleted under Indications and Limitations paragraph C. Effective 01/01/2011 (one).
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. Reformatted. No coverage changes (two).
11/21/2011 - 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:
93271 descriptor was changed in Group 1
05/01/2012: Addition of CPT codes 0295T, 0296T, 0297T and 0298T, effective 01/01/2012. Inclusion of Category III codes as payable when medically necessary and conditions of coverage have been met expands coverage. Thus no notice period applies. (three)
Reason for Change
HCPCS Addition/Deletion
Related Documents
This LCD has no Related Documents.
LCD Attachments
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