Revised Policies
The following are revised policies. To view the new policies on the WPS Medicare website, use the left hand navigation to go to the Local Policies (LCD). Be sure to note the effective date of the revision, as the revision will not appear in the Active policy until the effective date. Prior to the effective date, the revision can be found by selecting the link "Display Future Effective Documents" within the CMS Medicare Coverage Database(external link) (MCD).
February 2012
POLICIES WILL BE AVAILABLE ON THE CMS WEBSITE 01/26/12 AND ON THE WPS MEDICARE WEBSITE 02/07/12.
| Policy Title | MCD Policy # | WPS Policy # | Effective Date |
|---|---|---|---|
| Application of Bioengineered Skin Substitutes | L30135 | GSURG-052 | 02/01/2012 |
| Removed information regarding Medicare Physician Fee Schedule Database. | |||
| Botulinum Toxin Type A & Type B | L28555 | INJ-018 | 02/01/2012 |
| Removed information regarding Medicare Physician Fee Schedule Database. | |||
| Chemotherapy Drugs and their Adjuncts | L28576 | HONC-010 | 02/01/2012 |
Indications and Limitations of Coverage and/or Medical NecessityE. Monoclonal Antibodies that are useful in chemotherapeutic regimens:
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| Circulating Tumor Cell Marker Assays | L32218 | PATH-033 | 02/15/2012 |
| Annual code updates: Added codes 0279T and 0280T and removed code 86849. | |||
| Independent Diagnostic Testing Facilities (IDTFs) - Appendix A | L31626 | PHYS-078 | 01/01/2012 |
| The Appendix has been updated with the Supervising Physician and Technician qualifications for CPT codes 78579 and 78582:
Technician Qualification
Credentialed by ARRT:R.T.-N or CNMT
Supervising Physician Nuclear Medicine or Radiology | |||
| Magnetic Resonance Imaging | L28723 | RAD-024 | 01/01/2012 |
| Inadvertent omission of new for 2012 HCPCS code A9585. Effective 01/01/2012. | |||
| Podiatry Code List | N/A | N/A | 01/01/2012 |
| For services performed on and after 01/01/2012: The following procedure codes have been added, by the WPS Medicare medical director staff, to the list of HCPCS codes approved as payable for podiatrists: CPT codes 15271-15278. NOTE: Effective for services performed on and after dates of service 01/01/2012, the following CPT codes are deleted: 15320, 15321, 15335, 15336, 15340, 15341-15343, 15350, 15351, 15360, 15365, 15366, 15400, 15401, 15420, 15421, 15430. | |||
January 2012
POLICIES WILL BE AVAILABLE ON THE CMS WEBSITE 12/30/11 AND ON THE WPS MEDICARE WEBSITE 01/06/12.| Policy Title | MCD Policy # | WPS Policy # | Effective Date | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 2012 CPT/HCPCS Code Update | Various | Various | New Codes: 01/01/2012 Deleted Codes: 12/31/2011 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| The following Procedure Codes have been added or deleted from the listed Local Coverage Determination (LCD) polices for 2011. The new codes are effective for services performed on or after 01/01/2012; the deleted are effective until 12/31/2011 and will not include a 90-day grace period.
*Editor's Note: J3490, J9999, C9399, and A4641 are valid codes to identify not otherwise classified (NOC) drugs and radiopharmaceuticals that have not been assigned a true CPT/HCPCS code. They are listed in the table below to indicate that the NOC code is no longer valid to use for the drugs and radiopharmaceutical listed below which now have true HCPCS codes.
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| Application of Bioengineered Skin Substitutes | L30135 | GSURG-052 | 01/01/2012 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Added Q4121 TheraSkin®, per square centimeter for all dates of service, claims submitted on and after January 1, 2012.
New 2012 CPT codes dates of service on and after 01/01/2012:
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| Immune Globulins | L30147 | INJ-012 | 01/01/2012 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
2. Specific hyperimmune serum globulin includes several different disease-specific drugs.
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December 2011
POLICIES WILL BE AVAILABLE ON THE CMS WEBSITE 11/30/11 AND ON THE WPS MEDICARE WEBSITE 12/08/11.
| Policy Title | MCD Policy # | WPS Policy # | Effective Date |
|---|---|---|---|
| Cardiovascular Stress Testing | L28563 | CV-004 | Retroactive 02/16/2009 |
| ICD-9 Codes that Support Medical Necessity *425.0-425.9 Cardiomyopathy This is a correction to the previous policy update. | |||
| Chemotherapy Drugs and their Adjuncts & Billing and Coding Guidelines | L28576 | HONC-010 | 12/01/2011 |
| Indications and Limitations of Coverage and/or Medical Necessity E. Monoclonal Antibodies that are useful in chemotherapeutic regimens:
Coverage for PROVENGE®, Q2043, for asymptomatic or minimally symptomatic metastatic castrate-resistant Contractors shall not pay separately for routine costs associated with PROVENGE®, HCPCS Q2043, except for | |||
| Computerized Tomography (CAT Scans) | L28544 | RAD-033 | 10/01/2011 |
| ICD-9-CM 2012 update; CHEST AND THORAX (71250-71270) ICD-9 code 998.0 truncated to 998.00, 998.01, 998.02 and 998.09. LOWER EXTREMITY (73700-73706) ICD-9 code 718.60 deleted, effective 10/01/2011. | |||
| Drugs and Biologics (Non-chemotherapy) | L32013 | INJ-041 | 12/01/2011 |
| J1300 Eculizumab, 10 mg (SolirisTM) For the treatment of patients with atypical hemolytic uremic syndrome (aHUS) (283.11) to inhibit complement-mediated thrombotic microangiopathy. Effective 09/23/2011-FDA approval date. | |||
| Magnetic Resonance Angiography | L31355 | RAD-023 | 10/01/2011 |
| Inadvertent omission from ICD-9 list for CPT code 71555, new ICD-9 code V12.55. Effective 10/01/2011. | |||
| Magnetic Resonance Imaging | L28723 | RAD-024 | 10/01/2011 |
| Inadvertent omission of 726.13, new ICD-9 code for 2012 for CPT procedure UPPER EXTREMITY (73218-73223). ICD-9 code 718.60 invalid with 2012 revisions for CPT procedures LOWER EXTREMITY (73718-73723) effective 10/01/2011. | |||
| Radiation Oncology Including Intensity Modulated Radiation Therapy (IMRT) | L30316 | RAD-014 | 12/01/2011 |
| Added ICD-9 code 527.7 and removed reference to Proton beam therapy. | |||
