Policy Revision(s) for Multiple Billing and Coding Articles - Effective October 2, 2025

Date Posted: October 2, 2025

The following Billing and Coding Articles have been revised under contract numbers: 01112 (NCA), 01182 (SCA), 01212 (AS, GU, HI, and NMI), and 01312 (NV).

Medicare Coverage Database Number Billing and Coding Article Title and Revision Number
Medicare Coverage Database Number Billing and Coding Article Title and Revision Number
A53304 Billing and Coding: Medical Necessity of Therapy Services
A53352 Billing and Coding: Outpatient Therapy Biofeedback Training
A55044 Billing and Coding: Patients Supplied Donated or Free-of-Charge Drug
A56027 Billing and Coding: Piriformis Injections
A55774 Billing and Coding: Reporting a Non-Covered Test Performed in Preparation for a Non-Covered Procedure
A53359 Billing and Coding: Sacral Nerve Stimulation for Urinary and Fecal Incontinence
A53084 Billing and Coding: Sclerosing of Varicose Veins
A53972 Billing and Coding: Spinal Fusion Services: Documentation Requirements
A58578 Billing and Coding: Spinraza® (Nusinersen)
A57848 Billing and Coding: Tomosynthesis-Guided Breast Biopsy
A56025 Billing and Coding: Topical HBO and Physician Related Service Billing and Coding Guidelines
A53916 Dropless Cataract Surgery
A54919 Investigational Device Exemptions (IDE) - IDE Documentation Requirements for Studies with an FDA Approval dated January 01, 2015, or later
A56112 Non-Payment for Prefabricated Splints
A53893 Self-Administered Drugs - Process to Determine Which Drugs Are Usually Self-administered By the Patient
A55719 Sipuleucel-T (Provenge®) - Coverage Criteria for Prostate Cancer – Clarification
A53356 Sterilization
A55058 Waiver of Face-to-Face Visit for Home Dialysis Patients

Effective Date: October 2, 2025

Summary of Changes:

CONTRACTOR INFORMATION:

Added: JF contractor information

This update is to consolidate JE and JF to have one unified document and policy number.

Visit the Noridian Billing and Coding Articles webpage to view the complete listing of Billing and Coding articles and/or access the Active, Future, or Retired articles available in the CMS MCD.

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