RETIRED - Immunosuppressive Drugs DIF Eliminated

IMPORTANT: THIS DOCUMENT CONTAINS OUTDATED INFORMATION.Content Provided on this page contains outdated information and instruction and should not be considered current. Noridian is providing this archived information for research purposes only. This archived article contains previously issued instructions that have since been updated or are no longer applicable for Medicare billing purposes.

Article retired due to content incorporation into the applicable Local Coverage Determination or related Policy Article.

Original Effective Date: 04/01/2005
Revision Effective Date: 11/01/2013

In this update to the supplier manual, the Immunosuppressive Drugs local coverage determination (LCD) has been revised to eliminate the use of the DMERC Information Form (DIF), effective for dates of service on or after July 1, 2005. With the elimination of the DIF, suppliers should add modifier GY to claims if any of the coverage criteria for immunosuppressive drugs has not been met. In addition, suppliers should check claims closely to ensure that the ICD-9 diagnosis code on the claim accurately describes a covered transplant type. The following ICD-9 diagnosis codes are eligible for coverage under the Immunosuppressive Drugs benefit category:

  • V42.0 - Kidney
  • V42.1 - Heart
  • V42.6 - Lung
  • V42.7 - Liver
  • V42.81 - Bone Marrow
  • V42.82 - Peripheral Stem Cells
  • V42.83 - Pancreas
  • V42.84 - Intestines
  • V42.89 - Other (use for Pancreatic Islet Cell)
  • 996.81 - Complications of transplanted organs – Kidney
  • 996.82 - Complications of transplanted organs – Liver
  • 996.83 - Complications of transplanted organs – Heart
  • 996.84 - Complications of transplanted organs – Lung
  • 996.85 - Complications of transplanted organs – Bone Marrow
  • 996.86 - Complications of transplanted organs – Pancreas
  • 996.87 - Complications of transplanted organs – Intestine
  • 996.89 - Complications of transplanted organs – Other specified transplanted organ (e.g., pancreatic islet cells)

All other ICD-9 diagnosis codes will be denied as noncovered.


            Last Updated Thu, 10 Jan 2019 12:23:42 +0000