Corneal Pachymetry (L30485)
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
L30485 LCD Title Corneal Pachymetry Contractor's Determination Number OPHTH-025 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 03/18/2010 Original Determination Ending Date Revision Effective Date For services performed on or after 10/01/2011 Revision Ending Date |
CMS National Coverage Policy
42CFR410.32
Diagnostic tests may only be ordered by the treating physician (or
other treating practitioner acting within the scope of their licenses
and Medicare requirements)* who will use the results in management of
the beneficiary's specific medical problem and diagnostic tests payable
under the Physicians Fee Schedule must be furnished under the
appropriate level of supervision by a physician.
Indications and Limitations of Coverage and/or Medical Necessity
Corneal
Pachymetry (CP) is a measurement of the thickness of the cornea.
Cornea thickness provides indirect measurement of physiological function
of the cornea. The cornea is approximately 540 to 550 microns thick in
the center area and 1,000 microns (one millimeter) thick in the
periphery. The most common accepted technique for obtaining corneal
pachymetic measurement is ultrasound biometry due to its availability,
accuracy and cost effectiveness. CP can also be measured by optical low
coherence reflectometry
The evaluation of corneal thickness is a well-established procedure for studying corneal function in a number of medical disease conditions. There must be documented indications in the patients' medical record to substantiate medical necessity for testing. These disease conditions can be categorized into four groups:
Indications for Corneal Pachymetry
1. Disorders of endothelial cell function
2. Disorders of corneal thickness
3. Corneal transplantation
4. Ocular hypertension (OHT) and glaucoma
Groups 1, 2, and 3
Indications for groups 1, 2 and 3:
A. Management of corneal disease and corneal transplant surgery.
.
Limitations for groups 1, 2 and 3:
A. Payment frequency will be no more the once every six month, bilaterally, as indicated by the medical records.
Group 4
The utilization of CP in relation to OHT and glaucoma (Group 4) has been documented in recent studies demonstrating that intraocular pressure (IOP) measurements need to be adjusted for abnormally thick or thin corneas. The target IOP is lower for a thin cornea and higher for a thick cornea.
The decision to treat glaucoma or OHT with topical medications, systemic medications, laser surgery or intraocular surgery is made by the treating physician after analyzing:
Indications for group 4:
A. Ocular factors (various ocular parameters e.g. IOP, corneal thickness, optic nerve assessment, visual field results) and
B. General systemic factors including family history, age, anemia, systemic medication, diabetes, other vascular diseases, etc.
Limitations for group 4:
A. CP payment frequency for isolated category 4 criteria would be once in a patients' lifetime, bilaterally, as documented in the medical record for any individual provider or provider billing group.
B. In patients' who have had CP based on group 4 indications, and have subsequent corneal refractive surgery or transplant surgery, it may be medically appropriate to repeat the test.
The evaluation of corneal thickness is a well-established procedure for studying corneal function in a number of medical disease conditions. There must be documented indications in the patients' medical record to substantiate medical necessity for testing. These disease conditions can be categorized into four groups:
Indications for Corneal Pachymetry
1. Disorders of endothelial cell function
2. Disorders of corneal thickness
3. Corneal transplantation
4. Ocular hypertension (OHT) and glaucoma
Groups 1, 2, and 3
Indications for groups 1, 2 and 3:
A. Management of corneal disease and corneal transplant surgery.
.
Limitations for groups 1, 2 and 3:
A. Payment frequency will be no more the once every six month, bilaterally, as indicated by the medical records.
Group 4
The utilization of CP in relation to OHT and glaucoma (Group 4) has been documented in recent studies demonstrating that intraocular pressure (IOP) measurements need to be adjusted for abnormally thick or thin corneas. The target IOP is lower for a thin cornea and higher for a thick cornea.
The decision to treat glaucoma or OHT with topical medications, systemic medications, laser surgery or intraocular surgery is made by the treating physician after analyzing:
Indications for group 4:
A. Ocular factors (various ocular parameters e.g. IOP, corneal thickness, optic nerve assessment, visual field results) and
B. General systemic factors including family history, age, anemia, systemic medication, diabetes, other vascular diseases, etc.
Limitations for group 4:
A. CP payment frequency for isolated category 4 criteria would be once in a patients' lifetime, bilaterally, as documented in the medical record for any individual provider or provider billing group.
B. In patients' who have had CP based on group 4 indications, and have subsequent corneal refractive surgery or transplant surgery, it may be medically appropriate to repeat the test.
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 |
| 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 |
| 085x | Critical Access Hospital |
Revenue Codes:
Note: WPS has identified the Type of Bill (TOB) and Revenue Center (RC) codes applicable for use with the CPT/HCPCS codes included in this LCD. Providers are reminded that not all CPT/HCPCS codes listed can be billed with all TOB and/or RC codes listed. CPT/HCPCS codes are required to be billed with specific TOB and RC codes. Providers are encouraged to refer to the CMS Internet-Only Manual (IOM) Pub. 100-04 Claims Processing Manual for further guidance.
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.
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.Note: WPS has identified the Type of Bill (TOB) and Revenue Center (RC) codes applicable for use with the CPT/HCPCS codes included in this LCD. Providers are reminded that not all CPT/HCPCS codes listed can be billed with all TOB and/or RC codes listed. CPT/HCPCS codes are required to be billed with specific TOB and RC codes. Providers are encouraged to refer to the CMS Internet-Only Manual (IOM) Pub. 100-04 Claims Processing Manual for further guidance.
| 0320 | Radiology - Diagnostic - General Classification |
| 0341 | Nuclear Medicine - Diagnostic |
| 0350 | CT Scan - General Classification |
| 0402 | Other Imaging Services - Ultrasound |
| 0610 | Magnetic Resonance Technology (MRT) - General Classification |
| 0972 | Professional Fees - Radiology - Diagnostic |
| 76514 | OPHTHALMIC ULTRASOUND, DIAGNOSTIC; CORNEAL PACHYMETRY, UNILATERAL OR BILATERAL (DETERMINATION OF CORNEAL THICKNESS) |
ICD-9 Codes that Support Medical Necessity
Group 1 Indications
Disorders of Endothelial Cell Function
| 371.20 - 371.23 | CORNEAL EDEMA UNSPECIFIED - BULLOUS KERATOPATHY |
| 371.57 | ENDOTHELIAL CORNEAL DYSTROPHY |
| 371.58 | OTHER POSTERIOR CORNEAL DYSTROPHIES |
Disorders of Corneal Thickness
| 370.00 - 370.06 | CORNEAL ULCER UNSPECIFIED - PERFORATED CORNEAL ULCER |
| 371.03 | CENTRAL OPACITY OF CORNEA |
| 371.48 | PERIPHERAL DEGENERATIONS OF CORNEA |
| 371.60 - 371.62 | KERATOCONUS UNSPECIFIED - KERATOCONUS ACUTE HYDROPS |
| 371.70 - 371.72 | CORNEAL DEFORMITY UNSPECIFIED - DESCEMETOCELE |
Corneal Transplant
| 996.51 | MECHANICAL COMPLICATION OF PROSTHETIC CORNEAL GRAFT |
| 996.80 | COMPLICATIONS OF UNSPECIFIED TRANSPLANTED ORGAN |
| 996.88 | COMPLICATIONS OF TRANSPLANTED ORGAN, STEM CELL |
Ocular Hypertension (OHT) and Glaucoma
| 365.00 - 365.06 | PREGLAUCOMA UNSPECIFIED - PRIMARY ANGLE CLOSURE WITHOUT GLAUCOMA DAMAGE |
| 365.10 - 365.15 | OPEN-ANGLE GLAUCOMA UNSPECIFIED - RESIDUAL STAGE OF OPEN ANGLE GLAUCOMA |
| 365.20 - 365.24 | PRIMARY ANGLE-CLOSURE GLAUCOMA UNSPECIFIED - RESIDUAL STAGE OF ANGLE-CLOSURE GLAUCOMA |
| 365.31 - 365.32 | CORTICOSTEROID-INDUCED GLAUCOMA GLAUCOMATOUS STAGE - CORTICOSTEROID-INDUCED GLAUCOMA RESIDUAL STAGE |
| 365.41 - 365.44 | GLAUCOMA ASSOCIATED WITH CHAMBER ANGLE ANOMALIES - GLAUCOMA ASSOCIATED WITH SYSTEMIC SYNDROMES |
| 365.51 - 365.59 | PHACOLYTIC GLAUCOMA - GLAUCOMA ASSOCIATED WITH OTHER LENS DISORDERS |
| 365.60 - 365.65 | GLAUCOMA ASSOCIATED WITH UNSPECIFIED OCULAR DISORDER - GLAUCOMA ASSOCIATED WITH OCULAR TRAUMA |
| 365.70 - 365.74 | GLAUCOMA STAGE, UNSPECIFIED - INDETERMINATE STAGE GLAUCOMA |
| 365.81 - 365.89 | HYPERSECRETION GLAUCOMA - OTHER SPECIFIED GLAUCOMA |
| 365.9 | UNSPECIFIED GLAUCOMA |
Diagnoses that Support Medical Necessity
Any listed above
ICD-9 Codes that DO NOT Support Medical Necessity
Any not listed above
ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation
Diagnoses that DO NOT Support Medical Necessity
Any not listed above
General Information
1. Physician
Services and diagnostic tests must be submitted with an ICD-9 code to
support medical necessity and must be coded to the greatest level of
accuracy and highest level of digit completeness. This means the
precise ICD-9 code that most fully explains the narrative description of
the diagnosis contained in the medical record or test interpretation
and report including the 4th or 5th digit subclassification for that
diagnosis category. The ICD-9 code based on the results of the
diagnostic test should be reported as the primary diagnosis. If the
diagnostic test results are normal or inconclusive the ICD-9 code
representing the sign, symptom, illness or injury prompting the ordering
of the test should be reported as the primary diagnosis. In the
absence of signs, symptoms, illness or injury a screening ICD-9 should
be reported, and payment will be denied. Ref. CMS Pub.100-04 Ch. 23
§§10.1-10.1.7
2. The patient's medical records should be legible, contain the relevant medical history and physical findings conforming to the criteria stated in the Indication and Limitations of Coverage and/or Medical Necessity section of this policy. Records must be made available to the Carrier on request.
Appendices
2. The patient's medical records should be legible, contain the relevant medical history and physical findings conforming to the criteria stated in the Indication and Limitations of Coverage and/or Medical Necessity section of this policy. Records must be made available to the Carrier on request.
The utilization of
CP for Group 1, 2, and 3 will be no more the once every six month, as
indicated by the medical records. (Refer to Indications and Limitations
of Coverage and/or Medical Necessity section)
The utilization of CP Group 4 criteria would be once in patients' lifetime, as documented in the medical record. In patients' who have subsequent corneal refractive surgery or transplant surgery, it may be appropriate to repeat the test if medically indicated, based on the group 4 criteria. (Refer to Indications and Limitations of Coverage and/or Medical Necessity section)
More frequent CP may be approved when submitted with documentation describing the medical circumstance relating to the patient's condition explaining the need for more frequent services.
This service is considered a bilateral service and will, therefore, be paid once whether one or both eyes are tested.
CP measurement is not considered medically reasonable and necessary when performed prior to routine cataract surgery unless corneal disease is documented.
For routine glaucoma screening see CMS Pub100-02 Ch. §280.1 and CMS Pub.100-04 Ch.18 §§70-70.3.
If there is evidence of corneal endothelial dysfunction prior to cataract surgery, and the purpose of corneal pachymetry is to aid in the decision whether to perform a combined corneal transplant plus cataract surgery or cataract surgery alone, corneal pachymetry may be medically reasonable and necessary.
Other Comments The "Coding Guidelines" and the "Reasons for Denial" can be found in a companion document. See Article. Corneal Pachymetry; Coding and Billing Guidelines
An asterisk (*) indicates a revision to that section of the policy.
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 with facilities that have nominated Wisconsin Physician Services (formerly Mutual of Omaha) to process their claims
This policy does not reflect the sole opinion of the contractor or Contractor Medical Director. Although the final decision rests with the contractor, this policy was developed in cooperation with advisory groups, which includes representatives from Ophthalmology.
Sources of Information and Basis for Decision
The utilization of CP Group 4 criteria would be once in patients' lifetime, as documented in the medical record. In patients' who have subsequent corneal refractive surgery or transplant surgery, it may be appropriate to repeat the test if medically indicated, based on the group 4 criteria. (Refer to Indications and Limitations of Coverage and/or Medical Necessity section)
More frequent CP may be approved when submitted with documentation describing the medical circumstance relating to the patient's condition explaining the need for more frequent services.
This service is considered a bilateral service and will, therefore, be paid once whether one or both eyes are tested.
CP measurement is not considered medically reasonable and necessary when performed prior to routine cataract surgery unless corneal disease is documented.
For routine glaucoma screening see CMS Pub100-02 Ch. §280.1 and CMS Pub.100-04 Ch.18 §§70-70.3.
If there is evidence of corneal endothelial dysfunction prior to cataract surgery, and the purpose of corneal pachymetry is to aid in the decision whether to perform a combined corneal transplant plus cataract surgery or cataract surgery alone, corneal pachymetry may be medically reasonable and necessary.
Other Comments The "Coding Guidelines" and the "Reasons for Denial" can be found in a companion document. See Article. Corneal Pachymetry; Coding and Billing Guidelines
An asterisk (*) indicates a revision to that section of the policy.
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 with facilities that have nominated Wisconsin Physician Services (formerly Mutual of Omaha) to process their claims
This policy does not reflect the sole opinion of the contractor or Contractor Medical Director. Although the final decision rests with the contractor, this policy was developed in cooperation with advisory groups, which includes representatives from Ophthalmology.
Brandt J., Beiser
J., Kass M., et al. (2001). Central corneal thickness in ocular
hypertension treatment study (OHTS). Ophthalmology Vol. 108 1779-1788
Doughty M., Zaman M., (2000). Human corneal thickness and its impact on intraocular pressure measures; A review and meta-analysis approach. Surv Ophthalmology, Vol. 44 367-408 (March-April)
Gordon, M., Beiser J., Brandt J., et al. (2002) The ocular hypertension treatment study. Arch Ophthalmology, Vol. 120 (June)
Herndon L., et al. (1997) Central corneal thickness in normal glaucomatous and ocular hypertensive eyes. Arch. Ophththalmology, Vol. 115 (Sept.)
Oh K., Weil L., et al (1998). Corneal thickness in Fuchs's dystrophy with and without epithelial edema. Eye Vol. 12 (Pt 2) 282-4
Parrish R., (2002) What clinicians can learn from OHTS. Review of Ophthalmology (Sept.)
Other Carrier policies
Advisory Committee Meeting Notes
Doughty M., Zaman M., (2000). Human corneal thickness and its impact on intraocular pressure measures; A review and meta-analysis approach. Surv Ophthalmology, Vol. 44 367-408 (March-April)
Gordon, M., Beiser J., Brandt J., et al. (2002) The ocular hypertension treatment study. Arch Ophthalmology, Vol. 120 (June)
Herndon L., et al. (1997) Central corneal thickness in normal glaucomatous and ocular hypertensive eyes. Arch. Ophththalmology, Vol. 115 (Sept.)
Oh K., Weil L., et al (1998). Corneal thickness in Fuchs's dystrophy with and without epithelial edema. Eye Vol. 12 (Pt 2) 282-4
Parrish R., (2002) What clinicians can learn from OHTS. Review of Ophthalmology (Sept.)
Other Carrier policies
Advisory Committee Meeting Notes
Meeting Date:
Wisconsin: 09/25/2009
Illinois: 09/16/2009
Michigan: 09/08/2009
Minnesota: 09/24/2009
Iowa, Kansas, Missouri, Nebraska 10/08/2009
Open Meeting: 08/19/2009
Start Date of Comment Period
Meeting Date:
Wisconsin: 09/25/2009
Illinois: 09/16/2009
Michigan: 09/08/2009
Minnesota: 09/24/2009
Iowa, Kansas, Missouri, Nebraska 10/08/2009
Open Meeting: 08/19/2009
10/08/2009
End Date of Comment Period
11/23/2009
Start Date of Notice Period
02/01/2010
Revision History Number
x
Revision History Explanation
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 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 85 was changed
8/1/2010 - Revenue code 0343 was added to the code range 0340 - 0349
8/1/2010 - Revenue code 0344 was added to the code range 0340 - 0349
8/1/2010 - The description for Revenue code 0320 was changed
8/1/2010 - The description for Revenue code 0321 was changed
8/1/2010 - The description for Revenue code 0322 was changed
8/1/2010 - The description for Revenue code 0323 was changed
8/1/2010 - The description for Revenue code 0324 was changed
8/1/2010 - The description for Revenue code 0329 was changed
8/1/2010 - The description for Revenue code 0340 was changed
8/1/2010 - The description for Revenue code 0341 was changed
8/1/2010 - The description for Revenue code 0342 was changed
8/1/2010 - The description for Revenue code 0349 was changed
8/1/2010 - The description for Revenue code 0350 was changed
8/1/2010 - The description for Revenue code 0351 was changed
8/1/2010 - The description for Revenue code 0352 was changed
8/1/2010 - The description for Revenue code 0359 was changed
8/1/2010 - The description for Revenue code 0400 was changed
8/1/2010 - The description for Revenue code 0401 was changed
8/1/2010 - The description for Revenue code 0402 was changed
8/1/2010 - The description for Revenue code 0403 was changed
8/1/2010 - The description for Revenue code 0404 was changed
8/1/2010 - The description for Revenue code 0409 was changed
8/1/2010 - The description for Revenue code 0610 was changed
8/1/2010 - The description for Revenue code 0611 was changed
8/1/2010 - The description for Revenue code 0612 was changed
8/1/2010 - The description for Revenue code 0614 was changed
8/1/2010 - The description for Revenue code 0615 was changed
8/1/2010 - The description for Revenue code 0616 was changed
8/1/2010 - The description for Revenue code 0618 was changed
8/1/2010 - The description for Revenue code 0619 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:
76514 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. Revised revenue codes per 2011 update. Removed word bilateral from the Utilzation Guidelines section. Minor formatting revisions. No coverage changes (one).
08/27/2011 - This policy was updated by the ICD-9 2011-2012 Annual Update.
10/11/2011: ICD-9-CM 2012 revisions; Added to group 3, new ICD-9-CM code 996.88. Added to group 4, new ICD-9-CM codes 365.05, 365.06, 365.70, 365.71, 365.72, 365.73 and 365.74. Effective 10/01/2012 (two).
Reason for Change
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 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 85 was changed
8/1/2010 - Revenue code 0343 was added to the code range 0340 - 0349
8/1/2010 - Revenue code 0344 was added to the code range 0340 - 0349
8/1/2010 - The description for Revenue code 0320 was changed
8/1/2010 - The description for Revenue code 0321 was changed
8/1/2010 - The description for Revenue code 0322 was changed
8/1/2010 - The description for Revenue code 0323 was changed
8/1/2010 - The description for Revenue code 0324 was changed
8/1/2010 - The description for Revenue code 0329 was changed
8/1/2010 - The description for Revenue code 0340 was changed
8/1/2010 - The description for Revenue code 0341 was changed
8/1/2010 - The description for Revenue code 0342 was changed
8/1/2010 - The description for Revenue code 0349 was changed
8/1/2010 - The description for Revenue code 0350 was changed
8/1/2010 - The description for Revenue code 0351 was changed
8/1/2010 - The description for Revenue code 0352 was changed
8/1/2010 - The description for Revenue code 0359 was changed
8/1/2010 - The description for Revenue code 0400 was changed
8/1/2010 - The description for Revenue code 0401 was changed
8/1/2010 - The description for Revenue code 0402 was changed
8/1/2010 - The description for Revenue code 0403 was changed
8/1/2010 - The description for Revenue code 0404 was changed
8/1/2010 - The description for Revenue code 0409 was changed
8/1/2010 - The description for Revenue code 0610 was changed
8/1/2010 - The description for Revenue code 0611 was changed
8/1/2010 - The description for Revenue code 0612 was changed
8/1/2010 - The description for Revenue code 0614 was changed
8/1/2010 - The description for Revenue code 0615 was changed
8/1/2010 - The description for Revenue code 0616 was changed
8/1/2010 - The description for Revenue code 0618 was changed
8/1/2010 - The description for Revenue code 0619 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:
76514 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. Revised revenue codes per 2011 update. Removed word bilateral from the Utilzation Guidelines section. Minor formatting revisions. No coverage changes (one).
08/27/2011 - This policy was updated by the ICD-9 2011-2012 Annual Update.
10/11/2011: ICD-9-CM 2012 revisions; Added to group 3, new ICD-9-CM code 996.88. Added to group 4, new ICD-9-CM codes 365.05, 365.06, 365.70, 365.71, 365.72, 365.73 and 365.74. Effective 10/01/2012 (two).
This LCD has no Related Documents.
LCD Attachments
Billing and Coding Guidelines 04/01/2011 (PDF - 13 KB )
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Page Last Updated: Thursday, 20-Oct-2011 15:44:31 CDT
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