Mohs Micrographic Surgery (L30713)
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
L30713 LCD Title Mohs Micrographic Surgery Contractor's Determination Number DERM-004 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 03/01/2012 Revision Ending Date |
CMS National Coverage Policy
Title XVIII of the Social Security Act (SSA):
Title XVIII of the Social Security Act, Section 1862 (a) (1)(A), this section allows coverage and payment for only those services considered medically reasonable and necessary.
Title XVIII of the Social Security Act, Section 1833 (e), this section prohibits Medicare payment for any claim which lacks the necessary information to process the claim.
CMS Publications:
CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 30, Physician Services
CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 16, Section 120, Cosmetic Surgery
CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 12 Section 40-40.6, Surgeons and Global Surgery
CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 12, Section 60, Payment for Pathology Services
CMS Transmittal No. 434, Publication 100-04, Medicare Claims Processing Manual, Change Request #3458, January 14, 2005, Addition of CLIA Edits to Certain Health Care Procedure Coding System (HCPCS) Codes for Mohs Surgery.
Title XVIII of the Social Security Act, Section 1862 (a) (1)(A), this section allows coverage and payment for only those services considered medically reasonable and necessary.
Title XVIII of the Social Security Act, Section 1833 (e), this section prohibits Medicare payment for any claim which lacks the necessary information to process the claim.
CMS Publications:
CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 30, Physician Services
CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 16, Section 120, Cosmetic Surgery
CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 12 Section 40-40.6, Surgeons and Global Surgery
CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 12, Section 60, Payment for Pathology Services
CMS Transmittal No. 434, Publication 100-04, Medicare Claims Processing Manual, Change Request #3458, January 14, 2005, Addition of CLIA Edits to Certain Health Care Procedure Coding System (HCPCS) Codes for Mohs Surgery.
Indications and Limitations of Coverage and/or Medical Necessity
Mohs
micrographic surgery is a two-step process: the tumor is removed in
stages, followed by immediate histologic evaluation of the margins of
the specimen(s). Further excision is performed until all margins are
clear. The physician performing MMS furnishes both the surgical and
pathological services, i.e., the excision and the histologic evaluation
of the specimen(s). Mohs surgery is usually an outpatient procedure
done under local anesthesia (with or without sedation).
The majority of simple skin cancers can be managed by simple excision or destruction techniques. The medical records should clearly show that Mohs surgery was chosen because of the complexity (e.g. poorly defined clinical borders, possible deep invasion, prior irradiation), size or location (e.g. maximum conservation of tumor-free tissue is important).
Indications:
Medicare will consider reimbursement for Mohs micrographic surgery for the following indications:
Basal cell, squamous cell, or basalosquamous cell carcinomas in anatomic locations where they are prone to recur:
- Mask area of the face (central face, eyelids, eyebrows, periorbital areas, nose, lips, chin, mandible, periauricular areas, ear, temple, sulci);
- Forehead, cheeks, and neck;
- Genitalia;
- Hands & feet;
- Scalp.
Basal cell carcinomas, squamous cell carcinomas, or basalosquamous carcinomas that have one or more of the following features:
- Recurrent tumor;
- Aggressive pathology;
- Large size (2.0 cm or greater);
- Positive margins on recent excision;
- Poorly defined borders;
- In the very young (<40 yr. Age);
- Radiation-induced;
- In patients with proven difficulty with skin cancers or who are immunocompromised;
- In an old scar (e.g., a marjolin's ulcer);
- Associated with xeroderma pigmentosum;
- Deeply infiltrating lesion or difficulty estimating depth of lesion;
- Perineural invasion on biopsy.
Squamous cell carcinoma exhibiting any of the following:
- Acantholytic histology;
- Rapid growth;
- Longstanding duration.
Basal cell nevus syndrome
Other skin lesions:
- Angiosarcoma of the skin;
- Keratoacanthoma;
- Dermatofibrosarcoma protuberans;
- Malignant fibrous histiocytoma;
- Sebaceous gland carcinoma;
- Microcystic adnexal carcinoma;
- Extramammary paget's disease;
- Bowenoid papulosis;
- Merkel cell carcinoma;
- Bowen's disease (squamous cell carcinoma in situ);
- Verrucous carcinoma;
- Atypical fibroxanthoma;
- Leiomyosarcoma or other spindle cell neoplasms of the skin;
- Adenocystic carcinoma of the skin;
- Erythroplasia of queryrat;
- Apocrine or eccrine carcinoma of the skin;
- Malignant melanoma and lentigo maligna when anatomical or technical difficulties do not allow conventional excision with appropriate margins.
Limitations:
The physician (MD/DO) performing Mohs micrographic surgery must be specifically trained and highly skilled in MMS techniques and pathologic identification.
If a surgeon performs an excision using Mohs surgical techniques, but does not personally provide the histologic evaluation of the specimen(s), the CPT codes for MMS included in this LCD may not be used. Standard excision codes should be chosen for such services (e.g., 11600 - 11646).
Only physicians (MD/DO) may perform Mohs micrographic surgery. (See Sections 1861 [s] [2] and 1862 [a] [140 of Title XVIII of the Social Security Act; 42 CFR, Sections 410.74, 410.75, 410.76 and 419.22; 58 FR 18543, April 7, 2000.)
Medicare is aware that a biopsy of the skin lesion for which Mohs surgery is planned may be necessary in order for the physician to determine the exact nature of the lesion(s) to be removed. Occasionally, that biopsy may need to be done on the same day that the Mohs surgery is planned. In order to allow separate payment for a biopsy and pathology on the same day as Mohs surgery, the -59 modifier is appropriate. The 59 modifier is also appropriate when a separate skin lesion, other than the lesion for which Mohs surgery is performed, is biopsied on the same day that the Mohs surgery is performed.
For outpatient settings other than Comprehensive Outpatient Rehabilitation Facility (CORFs), references to "physicians" throughout this policy include non-physicians, such as nurse practitioners, clinical nurse specialists and physician assistants. Such non-physician practitioners, with certain exceptions, may certify, order and establish the plan of care for Mohs surgery as authorized by State law.
The majority of simple skin cancers can be managed by simple excision or destruction techniques. The medical records should clearly show that Mohs surgery was chosen because of the complexity (e.g. poorly defined clinical borders, possible deep invasion, prior irradiation), size or location (e.g. maximum conservation of tumor-free tissue is important).
Indications:
Medicare will consider reimbursement for Mohs micrographic surgery for the following indications:
Basal cell, squamous cell, or basalosquamous cell carcinomas in anatomic locations where they are prone to recur:
- Mask area of the face (central face, eyelids, eyebrows, periorbital areas, nose, lips, chin, mandible, periauricular areas, ear, temple, sulci);
- Forehead, cheeks, and neck;
- Genitalia;
- Hands & feet;
- Scalp.
Basal cell carcinomas, squamous cell carcinomas, or basalosquamous carcinomas that have one or more of the following features:
- Recurrent tumor;
- Aggressive pathology;
- Large size (2.0 cm or greater);
- Positive margins on recent excision;
- Poorly defined borders;
- In the very young (<40 yr. Age);
- Radiation-induced;
- In patients with proven difficulty with skin cancers or who are immunocompromised;
- In an old scar (e.g., a marjolin's ulcer);
- Associated with xeroderma pigmentosum;
- Deeply infiltrating lesion or difficulty estimating depth of lesion;
- Perineural invasion on biopsy.
Squamous cell carcinoma exhibiting any of the following:
- Acantholytic histology;
- Rapid growth;
- Longstanding duration.
Basal cell nevus syndrome
Other skin lesions:
- Angiosarcoma of the skin;
- Keratoacanthoma;
- Dermatofibrosarcoma protuberans;
- Malignant fibrous histiocytoma;
- Sebaceous gland carcinoma;
- Microcystic adnexal carcinoma;
- Extramammary paget's disease;
- Bowenoid papulosis;
- Merkel cell carcinoma;
- Bowen's disease (squamous cell carcinoma in situ);
- Verrucous carcinoma;
- Atypical fibroxanthoma;
- Leiomyosarcoma or other spindle cell neoplasms of the skin;
- Adenocystic carcinoma of the skin;
- Erythroplasia of queryrat;
- Apocrine or eccrine carcinoma of the skin;
- Malignant melanoma and lentigo maligna when anatomical or technical difficulties do not allow conventional excision with appropriate margins.
Limitations:
The physician (MD/DO) performing Mohs micrographic surgery must be specifically trained and highly skilled in MMS techniques and pathologic identification.
If a surgeon performs an excision using Mohs surgical techniques, but does not personally provide the histologic evaluation of the specimen(s), the CPT codes for MMS included in this LCD may not be used. Standard excision codes should be chosen for such services (e.g., 11600 - 11646).
Only physicians (MD/DO) may perform Mohs micrographic surgery. (See Sections 1861 [s] [2] and 1862 [a] [140 of Title XVIII of the Social Security Act; 42 CFR, Sections 410.74, 410.75, 410.76 and 419.22; 58 FR 18543, April 7, 2000.)
Medicare is aware that a biopsy of the skin lesion for which Mohs surgery is planned may be necessary in order for the physician to determine the exact nature of the lesion(s) to be removed. Occasionally, that biopsy may need to be done on the same day that the Mohs surgery is planned. In order to allow separate payment for a biopsy and pathology on the same day as Mohs surgery, the -59 modifier is appropriate. The 59 modifier is also appropriate when a separate skin lesion, other than the lesion for which Mohs surgery is performed, is biopsied on the same day that the Mohs surgery is performed.
For outpatient settings other than Comprehensive Outpatient Rehabilitation Facility (CORFs), references to "physicians" throughout this policy include non-physicians, such as nurse practitioners, clinical nurse specialists and physician assistants. Such non-physician practitioners, with certain exceptions, may certify, order and establish the plan of care for Mohs surgery as authorized by State law.
Coding Information
Bill Type Codes:
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
| 011x | Hospital Inpatient (Including Medicare Part A) |
| 013x | Hospital Outpatient |
| 071x | Clinic - Rural Health |
| 073x | Clinic - Freestanding |
| 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.
| 036X | Operating Room Services - General Classification |
| 051X | Clinic - General Classification |
| 052X | Free-Standing Clinic - General Classification |
| 0761 | Specialty Services - Treatment Room |
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 Surgery, Nuclear Medicine, Medical and Radiation Oncology.
| 17311 | MOHS MICROGRAPHIC TECHNIQUE, INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL EXCISION OF TISSUE SPECIMENS, MAPPING, COLOR CODING OF SPECIMENS, MICROSCOPIC EXAMINATION OF SPECIMENS BY THE SURGEON, AND HISTOPATHOLOGIC PREPARATION INCLUDING ROUTINE STAIN(S) (EG, HEMATOXYLIN AND EOSIN, TOLUIDINE BLUE), HEAD, NECK, HANDS, FEET, GENITALIA, OR ANY LOCATION WITH SURGERY DIRECTLY INVOLVING MUSCLE, CARTILAGE, BONE, TENDON, MAJOR NERVES, OR VESSELS; FIRST STAGE, UP TO 5 TISSUE BLOCKS |
| 17312 | MOHS MICROGRAPHIC TECHNIQUE, INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL EXCISION OF TISSUE SPECIMENS, MAPPING, COLOR CODING OF SPECIMENS, MICROSCOPIC EXAMINATION OF SPECIMENS BY THE SURGEON, AND HISTOPATHOLOGIC PREPARATION INCLUDING ROUTINE STAIN(S) (EG, HEMATOXYLIN AND EOSIN, TOLUIDINE BLUE), HEAD, NECK, HANDS, FEET, GENITALIA, OR ANY LOCATION WITH SURGERY DIRECTLY INVOLVING MUSCLE, CARTILAGE, BONE, TENDON, MAJOR NERVES, OR VESSELS; EACH ADDITIONAL STAGE AFTER THE FIRST STAGE, UP TO 5 TISSUE BLOCKS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 17313 | MOHS MICROGRAPHIC TECHNIQUE, INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL EXCISION OF TISSUE SPECIMENS, MAPPING, COLOR CODING OF SPECIMENS, MICROSCOPIC EXAMINATION OF SPECIMENS BY THE SURGEON, AND HISTOPATHOLOGIC PREPARATION INCLUDING ROUTINE STAIN(S) (EG, HEMATOXYLIN AND EOSIN, TOLUIDINE BLUE), OF THE TRUNK, ARMS, OR LEGS; FIRST STAGE, UP TO 5 TISSUE BLOCKS |
| 17314 | MOHS MICROGRAPHIC TECHNIQUE, INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL EXCISION OF TISSUE SPECIMENS, MAPPING, COLOR CODING OF SPECIMENS, MICROSCOPIC EXAMINATION OF SPECIMENS BY THE SURGEON, AND HISTOPATHOLOGIC PREPARATION INCLUDING ROUTINE STAIN(S) (EG, HEMATOXYLIN AND EOSIN, TOLUIDINE BLUE), OF THE TRUNK, ARMS, OR LEGS; EACH ADDITIONAL STAGE AFTER THE FIRST STAGE, UP TO 5 TISSUE BLOCKS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 17315 | MOHS MICROGRAPHIC TECHNIQUE, INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL EXCISION OF TISSUE SPECIMENS, MAPPING, COLOR CODING OF SPECIMENS, MICROSCOPIC EXAMINATION OF SPECIMENS BY THE SURGEON, AND HISTOPATHOLOGIC PREPARATION INCLUDING ROUTINE STAIN(S) (EG, HEMATOXYLIN AND EOSIN, TOLUIDINE BLUE), EACH ADDITIONAL BLOCK AFTER THE FIRST 5 TISSUE BLOCKS, ANY STAGE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
ICD-9 Codes that Support Medical Necessity
ICD-9-CM code 173.8 should only be used when reporting malignant neoplasms of contiguous or overlapping sites of skin whose point of origin cannot be determined.
| 140.0 - 140.4 | MALIGNANT NEOPLASM OF UPPER LIP VERMILION BORDER - MALIGNANT NEOPLASM OF LOWER LIP INNER ASPECT |
| 140.6 - 140.8 | MALIGNANT NEOPLASM OF COMMISSURE OF LIP - MALIGNANT NEOPLASM OF OTHER SITES OF LIP |
| 171.0 - 171.8 | MALIGNANT NEOPLASM OF CONNECTIVE AND OTHER SOFT TISSUE OF HEAD FACE AND NECK - MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF CONNECTIVE AND OTHER SOFT TISSUE |
| 172.0 - 172.8 | MALIGNANT MELANOMA OF SKIN OF LIP - MALIGNANT MELANOMA OF OTHER SPECIFIED SITES OF SKIN |
| 173.00 - 173.99 | UNSPECIFIED MALIGNANT NEOPLASM OF SKIN OF LIP - OTHER SPECIFIED MALIGNANT NEOPLASM OF SKIN, SITE UNSPECIFIED |
| 184.1 - 184.4 | MALIGNANT NEOPLASM OF LABIA MAJORA - MALIGNANT NEOPLASM OF VULVA UNSPECIFIED SITE |
| 184.8 | MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF FEMALE GENITAL ORGANS |
| 187.1 - 187.4 | MALIGNANT NEOPLASM OF PREPUCE - MALIGNANT NEOPLASM OF PENIS PART UNSPECIFIED |
| 187.7 | MALIGNANT NEOPLASM OF SCROTUM |
| 187.8 | MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF MALE GENITAL ORGANS |
| 209.31 - 209.36 | MERKEL CELL CARCINOMA OF THE FACE - MERKEL CELL CARCINOMA OF OTHER SITES |
| 232.0 - 232.8 | CARCINOMA IN SITU OF SKIN OF LIP - CARCINOMA IN SITU OF OTHER SPECIFIED SITES OF SKIN |
| 233.30 - 233.32 | CARCINOMA IN SITU, UNSPECIFIED FEMALE GENITAL ORGAN - CARCINOMA IN SITU, VULVA |
| 233.39 | CARCINOMA IN SITU, OTHER FEMALE GENITAL ORGAN |
| 233.5 | CARCINOMA IN SITU OF PENIS |
| 238.1 | NEOPLASM OF UNCERTAIN BEHAVIOR OF CONNECTIVE AND OTHER SOFT TISSUE |
Diagnoses that Support Medical Necessity
Not applicable
ICD-9 Codes that DO NOT Support Medical Necessity
Not applicable
ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation
Diagnoses that DO NOT Support Medical Necessity
General Information
The majority of
simple skin cancers can be managed by simple excision or destruction
techniques. The medical records should clearly show that Mohs surgery
was chosen because of the complexity, size and/or location of the
lesion.
The operative notes and pathology documentation in the patient's medical record must clearly show that Mohs micrographic surgery was performed using accepted Mohs technique, with the physician performing both the surgical and pathology services. The notes should also contain the location, number and size of the lesion(s), the number of stages performed, and the number of specimens per stage.
If reporting the -59 modifier with a skin biopsy/pathology code on the same day the Mohs surgery was performed, the physician's documentation should clearly indicate:
- That the biopsy was performed on a lesion other than the one on which Mohs surgery was performed;
- If the biopsy is of the same lesion as the Mohs lesion, that a biopsy of that lesion had not been done within the previous 60 days; or
- If there has been a recent (within 60 days) biopsy of the same lesion as the Mohs lesion, the results of that biopsy were unobtainable despite reasonable effort by the Mohs surgeon.
Documentation must be available to Medicare upon request.
The patient's medical record must contain documentation that fully supports the medical necessity for services included within this LCD. (See "indications and limitations of coverage.") This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
The operative notes and pathology documentation in the patient's medical record must clearly show that Mohs micrographic surgery was performed using accepted Mohs technique, with the physician performing both the surgical and pathology services. The notes should also contain the location, number and size of the lesion(s), the number of stages performed, and the number of specimens per stage.
If reporting the -59 modifier with a skin biopsy/pathology code on the same day the Mohs surgery was performed, the physician's documentation should clearly indicate:
- That the biopsy was performed on a lesion other than the one on which Mohs surgery was performed;
- If the biopsy is of the same lesion as the Mohs lesion, that a biopsy of that lesion had not been done within the previous 60 days; or
- If there has been a recent (within 60 days) biopsy of the same lesion as the Mohs lesion, the results of that biopsy were unobtainable despite reasonable effort by the Mohs surgeon.
Documentation must be available to Medicare upon request.
The patient's medical record must contain documentation that fully supports the medical necessity for services included within this LCD. (See "indications and limitations of coverage.") This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
Appendices
Utilization Guidelines
Not applicable
* - an asterisk indicates a revision to that section of the policy.
* - an asterisk indicates a revision to that section of the policy.
Sources of Information and Basis for Decision
Note: 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 includes representatives of various medical
specialty societies.
American Academy of Dermatology Guidelines: (1) "Guidelines of care for Mohs Micrographic Surgery", (2)"Guidelines of care for Malignant Melanoma"
American Academy of Dermatology: Principles' for Application of AMA-CPT Codes, http://www.aad.org/
Bowen, Glen M., M.D., White, George L., Jr., P.A.-C., M.S.P.H., PH.D, Gerwells, John W., M.D., Mohs Micrographic SurgeryAmerican Family Physician, September 1, 2005, Volume 72 (5), 845-848.
Habif, Thomas P., M.D., Squamous Cell Carcinoma, Habif: Clinical Dermatology, 4th Edition, Philadelphia, P.A., Mosby, Inc, 2004.
Lang, PG, Jr. M.D., The role of Mohs' Micrographic Surgery in the Management of Skin Cancer and a Perspective on the Management of the Surgical Defect. Clinics in Plastic Surgery, 01-Jan-2004, 31(1): 5-31.
Scheinfeld, Noah, M.D., J.D., Yu, Thomas, M.D., Weinberg, Jeffrey, M.D., et al, Cutaneous Oncologic and Cosmetic Surgery in Geriatric Patients, Dermatologic Clinics of North America, 2004, Vol 22, 97-113.
American Academy of Dermatology Guidelines: (1) "Guidelines of care for Mohs Micrographic Surgery", (2)"Guidelines of care for Malignant Melanoma"
American Academy of Dermatology: Principles' for Application of AMA-CPT Codes, http://www.aad.org/
Bowen, Glen M., M.D., White, George L., Jr., P.A.-C., M.S.P.H., PH.D, Gerwells, John W., M.D., Mohs Micrographic SurgeryAmerican Family Physician, September 1, 2005, Volume 72 (5), 845-848.
Habif, Thomas P., M.D., Squamous Cell Carcinoma, Habif: Clinical Dermatology, 4th Edition, Philadelphia, P.A., Mosby, Inc, 2004.
Lang, PG, Jr. M.D., The role of Mohs' Micrographic Surgery in the Management of Skin Cancer and a Perspective on the Management of the Surgical Defect. Clinics in Plastic Surgery, 01-Jan-2004, 31(1): 5-31.
Scheinfeld, Noah, M.D., J.D., Yu, Thomas, M.D., Weinberg, Jeffrey, M.D., et al, Cutaneous Oncologic and Cosmetic Surgery in Geriatric Patients, Dermatologic Clinics of North America, 2004, Vol 22, 97-113.
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 meeting 01/06/2010
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 meeting 01/06/2010
Start Date of Comment Period
02/19/2010
End Date of Comment Period
04/05/2010
Start Date of Notice Period
06/01/2011
Revision History Number
X
Revision History Explanation
8/1/2010 - The description for Bill Type Code 11 was changed
8/1/2010 - The description for Bill Type Code 13 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 - The description for Revenue code 0360 was changed
8/1/2010 - The description for Revenue code 0361 was changed
8/1/2010 - The description for Revenue code 0362 was changed
8/1/2010 - The description for Revenue code 0367 was changed
8/1/2010 - The description for Revenue code 0369 was changed
8/1/2010 - The description for Revenue code 0510 was changed
8/1/2010 - The description for Revenue code 0511 was changed
8/1/2010 - The description for Revenue code 0512 was changed
8/1/2010 - The description for Revenue code 0513 was changed
8/1/2010 - The description for Revenue code 0514 was changed
8/1/2010 - The description for Revenue code 0515 was changed
8/1/2010 - The description for Revenue code 0516 was changed
8/1/2010 - The description for Revenue code 0517 was changed
8/1/2010 - The description for Revenue code 0519 was changed
8/1/2010 - The description for Revenue code 0520 was changed
8/1/2010 - The description for Revenue code 0521 was changed
8/1/2010 - The description for Revenue code 0522 was changed
8/1/2010 - The description for Revenue code 0523 was changed
8/1/2010 - The description for Revenue code 0524 was changed
8/1/2010 - The description for Revenue code 0525 was changed
8/1/2010 - The description for Revenue code 0526 was changed
8/1/2010 - The description for Revenue code 0527 was changed
8/1/2010 - The description for Revenue code 0528 was changed
8/1/2010 - The description for Revenue code 0529 was changed
8/1/2010 - The description for Revenue code 0761 was changed
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:
17311 descriptor was changed in Group 1
17313 descriptor was changed in Group 1
17314 descriptor was changed in Group 1
17315 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, (One) corrected typo to add, in the Documentation requirements, the word simple to the sentence €œThe majority of simple skin cancers can be managed by simple excision or destruction techniques.€
08/27/2011 - This policy was updated by the ICD-9 2011-2012 Annual Update.
10/01/2011, (Two) 2012 ICD-9 update; ICD- 9 codes 173.0, 173.1, 173.3, 173.4, 173.5, 173.6, 173.7, 173.8 were truncated. Added 173.00, 173.01, 173.02, 173.09, 173.10, 173.11, 173.12, 173.19, 173.20, 173.21, 173.22, 173.29, 173.30, 173.31, 173.32, 173.39, 173.40, 173.41, 173.42, 173.49, 173.50, 173.51, 173.52, 173.59, 173.60, 173.61, 173.62, 173.69, 173.70, 173.71, 173.72, 173.79, 173.80, 173.81, 173.82, 173.89, 173.90, 173.91, 173.92, 173.99.
03/01/2012, added ICD-9 code 238.1
8/1/2010 - The description for Bill Type Code 13 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 - The description for Revenue code 0360 was changed
8/1/2010 - The description for Revenue code 0361 was changed
8/1/2010 - The description for Revenue code 0362 was changed
8/1/2010 - The description for Revenue code 0367 was changed
8/1/2010 - The description for Revenue code 0369 was changed
8/1/2010 - The description for Revenue code 0510 was changed
8/1/2010 - The description for Revenue code 0511 was changed
8/1/2010 - The description for Revenue code 0512 was changed
8/1/2010 - The description for Revenue code 0513 was changed
8/1/2010 - The description for Revenue code 0514 was changed
8/1/2010 - The description for Revenue code 0515 was changed
8/1/2010 - The description for Revenue code 0516 was changed
8/1/2010 - The description for Revenue code 0517 was changed
8/1/2010 - The description for Revenue code 0519 was changed
8/1/2010 - The description for Revenue code 0520 was changed
8/1/2010 - The description for Revenue code 0521 was changed
8/1/2010 - The description for Revenue code 0522 was changed
8/1/2010 - The description for Revenue code 0523 was changed
8/1/2010 - The description for Revenue code 0524 was changed
8/1/2010 - The description for Revenue code 0525 was changed
8/1/2010 - The description for Revenue code 0526 was changed
8/1/2010 - The description for Revenue code 0527 was changed
8/1/2010 - The description for Revenue code 0528 was changed
8/1/2010 - The description for Revenue code 0529 was changed
8/1/2010 - The description for Revenue code 0761 was changed
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:
17311 descriptor was changed in Group 1
17313 descriptor was changed in Group 1
17314 descriptor was changed in Group 1
17315 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, (One) corrected typo to add, in the Documentation requirements, the word simple to the sentence €œThe majority of simple skin cancers can be managed by simple excision or destruction techniques.€
08/27/2011 - This policy was updated by the ICD-9 2011-2012 Annual Update.
10/01/2011, (Two) 2012 ICD-9 update; ICD- 9 codes 173.0, 173.1, 173.3, 173.4, 173.5, 173.6, 173.7, 173.8 were truncated. Added 173.00, 173.01, 173.02, 173.09, 173.10, 173.11, 173.12, 173.19, 173.20, 173.21, 173.22, 173.29, 173.30, 173.31, 173.32, 173.39, 173.40, 173.41, 173.42, 173.49, 173.50, 173.51, 173.52, 173.59, 173.60, 173.61, 173.62, 173.69, 173.70, 173.71, 173.72, 173.79, 173.80, 173.81, 173.82, 173.89, 173.90, 173.91, 173.92, 173.99.
03/01/2012, added ICD-9 code 238.1
Reason for Change
ICD9 Addition/Deletion
Related Documents
This LCD has no Related Documents.
LCD Attachments
Billing & Coding Guidelines 6/1/11 (PDF - 28 KB)
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Page Last Updated: Thursday, 01-Mar-2012 11:32:01 CST
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