Medicare Coverage Articles

The term "article" is used to describe any bulletin article, website article, educational handout or any other non-LCD document intended for public release that contains coverage/coding statements or medical review related billing or claims considerations.

Medicare contractors post articles into the Medicare Coverage Database (MCD). Articles address local coverage, coding or medical review related billing and claims considerations, and may include any newly developed educational materials, coding instructions or clarification of existing medical review related billing or claims policy.

View coverage information on topics found outside NCDs and LCDs. As articles are updated in the MCD, they will be published as webpages here as well. Watch the below list continue to expand as updates are made.

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Topic Brief Description
Abbreviated Daytime Sleep Study (e.g. PAP-NAP) [PDF] View coverage and billing requirements for Abbreviated Daytime Sleep Studies
Additional Information Required for Coverage and Pricing for Category III CPT® Codes [PDF] View coverage and document requirements for Additional Information Required for Coverage and Pricing for Category III CPT® Codes Coverage.
Billing and Coding: Benign Skin Lesion Removal (Excludes Actinic Keratosis and MOHS) [PDF] View billing and coding requirements for the Benign Skin Lesion Removal (Excludes Actinic Keratosis and MOHS LCD.
Billing and Coding: Blepharoplasty, Eyelid Surgery, and Brow Lift [PDF] View billing and coding requirements for Blepharoplasty, Eyelid Surgery, and Brow Lift Policy
Billing and Coding: Botulinum Toxin Types A and B Policy [PDF] View billing and coding requirements for Botulinum Toxins Types A and B Policy.
Billing and Coding: B-type Natriuretic Peptide (BNP) Testing [PDF] View billing and coding requirements for B-type Natriuretic Peptide (BNP) Testing Policy.
Billing and Coding: Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography [PDF] View billing and coding requirements for Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography Policy.
Billing and Coding: Cataract Surgery in Adults [PDF] View billing and coding requirements for Cataract Surgery in Adults Policy
Billing and Coding: Chest X-Ray [PDF] View billing and coding requirements for Chest X-Ray Policy
Billing and Coding: Electrocardiograms [PDF] View billing and coding requirements for Electrocardiogram LCD.
Billing and Coding: Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification Tests (NAATs) [PDF] View billing and coding requirements for Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification Tests (NAATS) LCD.
Billing and Coding for Pathology Services on the Same Date of Service (DOS) as Mohs Surgery [PDF] View coverage and billing requirements for billing and coding for Pathology Services on the Same Date of Service (DOS) as Mohs Surgery Coverage.
Billing and Coding: Frequency of Hemodialysis [PDF] View coding and billing requirements for Hemodialysis Sessions.
Billing and Coding Guidelines: Truxima® (rituximab-abbs) [PDF] View billing and coding Guidelines for Truxima® (rituximab-abbs).
Billing and Coding: Helicobacter Pylori Infection Testing [PDF] View billing and coding requirements for Heliocobacter Pylori Infection Testing LCD.
Billing and Coding: HLA-DQB1*06:02 Testing for Narcolepsy [PDF] View billing and coding requirements for the HLA-DQB1*06:02 Testing for Narcolepsy LCD.
Billing and Coding: Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma [PDF] View billing and coding requirements for the Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma LCD.
Billing and Coding: Intensity Modulated Radiation Therapy (IMRT) [PDF] View billing and coding requirements for the Intensity Modulated Radiation Therapy (IMRT) LCD.
Billing and Coding: Lab: Bladder/Urothelial Tumor Markers [PDF] View billing and coding requirements for Lab: Bladder/Urothelial Tumor Markers LCD.
Billing and Coding: Lab: Coenzyme Q10 (CoQ10) [PDF] View billing and coding requirements for Lab: Coenzyme Q10 (CoQ10) LCD.
Billing and Coding: Lab: Controlled Substance Monitoring and Drugs of Abuse Testing [PDF] View billing and coding requirements for Lab: Controlled Substance Monitoring and Drugs of Abuse Testing Policy
Billing and Coding: Lab: Special Histochemical Stains and Immunohistochemical Stains [PDF] View billing and coding requirements for the Lab: Special Histochemical Stains and Immunohistochemical Stains LCD.
Billing and Coding: Lumbar Epidural Injections [PDF] View billing and coding requirements for Lumbar Epidural Injections LCD.
Billing and Coding: Lumbar MRI [PDF] View billing and coding requirements for Lumbar MRI LCD.
Billing and Coding: Measurement of Salivary Hormones [PDF] View billing and coding requirements for the Measurement of Salivary Hormones LCD.
Billing and Coding: MolDX: 4K Score Assay [PDF] View billing and coding requirements for the MolDX: 4K Score Assay LCD.
Billing and Coding: MolDX: Abbott RealTime IDH2 testing for Acute Myeloid Leukemia (AML) [PDF] View billing and coding requirements for the Abbott RealTime IDH2 testing for Acute Myeloid Leukemia (AML) LCD.
Billing and Coding: MolDX: Afirma™ Assay by Veracyte [PDF] View billing and coding requirements for the Afirma Assay by Veracyte.
Billing and Coding: MolDX: AlloMap [PDF] View billing and coding requirements for the Allomap testing.
Billing and Coding: MolDX: AlloSure® Donor-Derived Cell-Free DNA Test [PDF] View billing and coding requirements for the MolDX: AlloSure® Donor-Derived Cell-Free DNA Test LCD.
Billing and Coding: MolDX: APC and MUTYH Gene Testing [PDF] View billing and coding requirements for the MolDX: APC and MUTYH Gene Testing LCD.
Billing and Coding: MolDX: Avise PG Assay [PDF] View billing and coding requirements for the MolDX:Avise PG Assay LCD.
Billing and Coding: MolDX: BCR-ABL [PDF] View billing and coding requirements for MolDX: BCR-ABL
Billing and Coding: MolDX: BDX-XL2 [PDF] View billing and coding requirements for the MolDX: BDX-XL2 LCD
Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment [PDF] View billing and coding requirements for the LCD
Billing and Coding: MolDX: bioTheranostics Cancer TYPE ID® [PDF] View billing and coding requirements for the MolDX:bioTheranostics Cancer Type ID® LCD.
Billing and Coding: MolDX: BRCA1 and BRCA2 Genetic Testing [PDF] View billing and coding requirements for the MolDX: BRCA1 and BRCA2 Genetic Testing  LCD.
Billing and Coding: MolDX: Breast Cancer Assay: Prosigna [PDF] View billing and coding requirements for the MolDX: Breast Cancer Assay: Prosigna LCD.
Billing and Coding: MolDX: Corus CAD® Assay [PDF] View billing and coding requirements for the MolDX: Corus CAD® Assay LCD.
Billing and Coding: MolDX: Cystatin C Measurement [PDF] View billing and coding requirements for MolDX: Cystatin C Measurement LCD.
Billing and Coding: MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Very Low and Low Risk Disease [PDF] View billing and coding requirements for MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Very Low and Low Risk Disease LCD.
Billing and Coding: MolDX: DecisionDX-Melanoma [PDF] View billing and coding requirements for the MolDX: DecisionDX-Melanoma LCD.
Billing and Coding: MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test [PDF] View billing and coding requirements for the MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test LCD.
Billing and Coding: MolDX: FDA-Approved BRAF Tests [PDF] View billing and coding requirements for FDA-Approved BRAF testing.
Billing and Coding: MolDX: FDA-Approved EGFR Tests [PDF] View billing and coding requirements for the MolDX: FDA-Approved EGFR Tests LCD.
Billing and Coding: MolDX: FDA-Approved KRAS Tests [PDF] View billing and coding requirements for the MolDX: FDA-Approved KRAS LCD.
Billing and Coding: MolDX: Gaurdant360® Plasma Based Comprehensive Genomic Profiling in Non-Small Cell Lung Cancer (NSCLC) [PDF] View billing and coding requirements for MolDX: Gaurdant360® Plasma Based Comprehensive Genomic Profiling in Non-Small Cell Lung Cancer (NSCLC) LCD.
Billing and Coding: MolDX: GeneSight® Assay for Refractory Depression [PDF] View billing and coding requirements for GeneSight® Assay for Refractory Depression LCD.
Billing and Coding: MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease [PDF] View billing and coding requirements for the MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease LCD.
Billing and Coding: MolDX: Genetic Testing for Hypercoagulability/Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR) [PDF] View billing and coding requirements for the MolDX: Genetic Testing for the Hypercoagulability/Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR LCD.
Billing and Coding: MolDX: HERmark Assay by Monogram [PDF] View billing and coding requirements for the MolDX: HERmark Assay by Monogram LCD.
Billing and Coding: MolDX: HLA-B*15:02 Genetic Testing [PDF] View billing and coding requirements for the MolDX: HLA-B*15:02 Genetic Testing LCD.
Billing and Coding: MolDX: Inivata, inVisionFirst, Liquid Biopsy for Patients with Lung Cancer [PDF] View billing and coding requirements for MolDX: Inivata, InVisionFirst, Liquid Biopsy for Patients with Lung Cancer LCD.
Billing and Coding: MolDX: MammaPrint [PDF] View billing and coding requirements for the MolDX: MammaPrint LCD.
Billing and Coding: MolDX: MDS FISH [PDF] View billing and coding requirements for MolDX: MDS FISH LCD.
Billing and Coding: MolDX: MGMT Promoter Methylation Analysis [PDF] View billing and coding requirements for MolDX: MGMT Promoter Methylation Analysis LCD.
Billing and Coding: MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels [PDF] View coverage and billing requirements for MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels LCD.
Billing and Coding: MolDX: Myriad's BRACAnalysis CDx™ [PDF] View billing and coding requirements for the MolDX: Myriad's BRACAnalysis CDx™ LCA.
Billing and Coding: MolDX: NRAS Genetic Testing [PDF] View billing and coding requirements for the MolDX: NRAS Genetic Testing LCD.
Billing and Coding: MolDX: Oncotype DX AR-V7 Nucleus Detect for Men with Metastatic Castrate Resistant Prostate cancer (MCRPC) [PDF] View billing and coding requirements for the MolDX: Oncotype DX AR-V7 Nucleus Detect for Men with Metastatic Castrate Resistant Prostate cancer (MCRPC) LCD.
Billing and Coding: MolDX: Oncotype DX® Breast Cancer Assay [PDF] View billing and coding requirements for the MolDX: OncotypeDX® Breast Cancer Assay LCD.
Billing and Coding: MolDX: Oncotype DX® Colon Cancer [PDF] View billing and coding requirements for the MolDX: OncotypeDX® Colon Cancer Assay LCD.
Billing and Coding: MolDX: Percepta© Bronchial Genomic Classifier [PDF] View billing and coding requirements for the MolDX: Percepta© Bronchial Genomic Classifier LCD.
Billing and Coding: MolDX: Progensa® PCA3 Assay [PDF] View billing and coding requirements for the MolDX: Progensa® PCA3 Assay LCD.
Billing and Coding: MolDX: ProMark Risk Score [PDF] View billing and coding requirements for MolDX: ProMark Risk Score LCD.
Billing and Coding: MolDX: Prometheus IBD sgi Diagnostic Policy [PDF] View billing and coding requirements for the MolDX: Prometheus IBD sgi Diagnostic Policy LCD.
Billing and Coding: MolDx: ResponseDX Tissue of Origin® Billing and Coding Guidelines [PDF] View billing and coding requirements for the MolDX: ResponseDX Tissue of Origin® LCD.
Billing and Coding: MolDX: ThermoFisher Oncomine Dx Target Test for Non-Small Cell Lung Cancer [PDF] View billing and coding requirements for the MolDX: ThermoFisher Oncomine DX Target Test for Non-Small Cell Lung Cancer LCD.
Billing and Coding: MolDX: Vectra™ DA [PDF] View billing and coding requirements for the MolDX: Vectra™ DA LCD.
Billing and Coding: Molecular RBC Phenotyping [PDF] View billing and coding requirements for Molecular RBC Phenotyping LCD.
Billing and Coding: MRI and CT Scans of the Head and Neck [PDF] View billing and coding requirements for MRI and CT Scans of the Head and Neck LCD.
Billing and Coding: Plastic Surgery [PDF] View billing and coding requirements for Plastic Surgery Policy.
Billing and Coding: Respiratory Care (Respiratory Therapy) [PDF] View billing and coding requirements for Respiratory Care (Respiratory Therapy) LCD.
Billing and Coding: Serum Magnesium [PDF] View billing and coding requirements for Serum Magnesium LCD.
Billing and Coding: Treatment of Ulcers and Symptomatic Hyperkeratoses [PDF] View billing and coding requirements for Treatment of Ulcers and Symptomatic Hyperkeratoses LCD.
Billing Medicare for the SphenoCath and Other Similar Devices [PDF] View coverage and billing requirements for Billing Medicare for the SphenoCath® Device Coverage.
Chemotherapy Administration [PDF] View coverage and billing requirements for Chemotherapy Administration Coverage.
Coding Guidelines: Noninvasive Peripheral Venous Studies [PDF] View coding guidelines for Noninvasive Peripheral Venous Studies
Coverage of Intravenous Immune Globulin for Treatment of Primary Immune Deficiency Diseases in the Home - Medicare Benefit Policy Manual, Chapter 15, 50.6 [PDF] View coverage and billing requirements for IVIG for Treatment of Primary Immune Deficiency Diseases in the Home.
Dropless Cataract Surgery [PDF] View coverage and billing information for Dropless Cataract Surgery.
Flow Cytometry Coverage Clarification [PDF] View billing clarification for Flow Cytometry coverage.
High Compression Bandage System Clarification [PDF] View coverage and billing requirements for High Compression Bandage System Clarification Coverage.
Home PT/INR Monitoring (G0249) Billing and Coding [PDF] View coding and billing guidance related to the NCD for Home Prothrombin Time/International Normalized Ration Monitoring for Anticoagulation Monitoring.
Hydration Services [PDF] View coverage and billing requirements for Hydration Services Coverage.
Implantable Infusion Pumps for Chronic Pain [PDF] View information regarding implanted Infusion Pumps for Chronic pain and Compounded Drugs
In Vitro Chemosensitivity Assays-Billing and Coding Guidelines [PDF] View non-coverage and billing requirements for In Vitro Chemosensitivity Assays-Billing and Coding Guidelines
Incident To Clarification for OPPS and CAH Outpatient [PDF] View key points related to "incident to" regulations in an outpatient hospital setting
Intraocular Bevacizumab Coding/Billing Guidelines [PDF] View coverage and billing requirements for off-label use of bevacizumab for intravitreal injection.
Investigational Device Exemptions (IDE) - IDE Documentation Requirements for Studies with an FDA Approval dated January 01, 2015 or Later [PDF] View details regarding Medicare reimbursement for some investigational devices and related services. Coverage is contingent on the Medicare contractor's approval of the application for reimbursement.
IUD (Hormone-Eluting) for Endometrial Hyperplasia - CPT 58999 [PDF] View appropriate ICD-10 CM diagnoses for endometrial hyperplasia and use of CPT 58999.
JW Modifier Billing Guidelines [PDF] View coverage and billing requirements for JW Modifier Billing Guidelines article
Lab: Special Stains and Immunohistochemistry (IHC) Indications for Gastric Pathology [PDF] View coverage and billing requirements for IHC Indications for Gastric Pathology
Lymphedema Decongestive Treatment [PDF] View coverage and billing requirements for Lymphedema Decongestive Treatment Coverage.
Medical Necessity of Therapy Services [PDF] View coverage and billing requirements for Medical Necessity of Therapy Services Coverage.
MolDX: 4q25-AF Risk Genotype Billing and Coding Guidelines [PDF] View coverage and billing requirements for 4q25-AF Risk Genotype testing.
MolDX: 9p21 Genotype Test Billing and Coding Guidelines [PDF] View coverage and billing requirements for 9p21 Genotype testing.
MolDX: ApoE Genotype Billing and Coding Guidelines [PDF] View coverage and billing guidelines for ApoE Genotype testing.
MolDX: Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C) Testing Billing and Coding Guidelines [PDF] View coverage and billing requirements for Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C) Testing
MolDX: Aspartoacyclase 2 Deficiency (ASPA) Testing Billing and Coding Guidelines [PDF] View coverage and billing requirements for Aspartoacyclase 2 Deficiency (ASPA) Testing
MolDX: ATP7B Gene Tests Billing and Coding Guidelines [PDF] View coverage and billing requirements for  ATP7B gene testing.
MolDX: BCKDHB Gene Test Billing and Coding Guidelines [PDF] View coverage and billing requirements for BCKDHB Gene Testing.
MolDX: Billing and Coding for Lynch Syndrome Testing Services [PDF] View coverage and billing requirements for Lynch Syndrome Testing.
MolDX: BLM Gene Analysis Billing and Coding Guidelines [PDF] View coverage and billing requirements for BLM Gene Analysis.
MolDX: BluePrint® Billing and Coding Guidelines [PDF] View coverage and billing requirements for BluePrint®.
MolDX: CDH1 Genetic Testing Billing and Coding Guidelines [PDF] View coverage and billing requirements for MolDX CDH1 Genetic Testing
MolDX: CFTR Gene Analysis Coding and Billing Guidelines [PDF] Genetic testing for cystic fibrosis (CF) transmembrane conductance regulator (CFTR) is typically performed to screen adults with a positive family history of CF. Therefore, the MolDX team has determined that CFTR gene testing to identify parents at risk is not a Medicare benefit and is a statutorily excluded test.
MolDX: CHD7 Gene Analysis Coding and Billing Guidelines [PDF] MolDX has determined that CHD7 genetic testing performed during the diagnosis of CHARGE Syndrome is not a Medicare benefit and is a statutorily excluded service. MolDX will also deny tests that include one or more of CHD7 tests reported with CPT code 81479 as statutorily excluded services.
MolDX: Clonoseq® Assay for Assessment of Minimal Residual Disease (MRD) in Patients with Specific Lymphoid Malignancies [PDF] View coverage and billing requirements for MolDX: Clonoseq® Assay for Assessment of Minimal Residual Disease (MRD) in Patients with Specific Lymphoid Malignancies coverage.
MolDX: CYP2B6 Test Billing and Coding Guidelines [PDF] View coverage and billing requirements for CY2B6 testing.
MolDX: CYP2C9 and/or VKORC1 Gene Testing for Warfarin Response Billing and Coding Guidelines [PDF] View coverage and billing requirements for CYP2C9/VKORC1 gene testing for Warfarin.
MolDX: ENG and ACVRL1 Gene Tests Billing and Coding Guidelines [PDF] View coverage and billing requirements for ENG and ACVRL1 Gene Tests.
MolDX: FANCC Genetic Testing Billing and Coding Guidelines [PDF] View coverage and billing guidelines for FANCC Genetic testing.
MolDX: FDA Approved CLL Companion Diagnostic Test Billing and Coding Guidelines [PDF] View coverage and billing requirements for MolDX: FDA Approved CLL Companion Diagnostic Testing
MolDX: Fragile X Billing and Coding Guidelines Update [PDF] View coverage and billing requirements for Fragile X.
MolDX: GBA Genetic Testing Billing and Coding Guidelines [PDF] View coverage and billing requirements for Abbreviated Daytime Sleep Studies
MolDX HAX1 Gene Sequencing Billing and Coding Guidelines [PDF] View coverage and billing requirements for HAX1 Gene Sequencing.
MolDX: HBB Gene Tests Billing and Coding Guidelines [PDF] View coverage and billing requirements for MolDX: HBB Gene Tests.
MolDX: HEXA Gene Analysis Billing and Coding Guidelines [PDF] View coverage and billing requirements for HEXA Gene Analysis 
MolDX: HTTLPR Gene Testing Billing and Billing Guidelines Guidelines [PDF] View coverage and billing requirements for HTTLPR gene testing.
MolDX: IKBKAP Genetic Testing Billing and Coding Guidelines [PDF] View coverage and billing requirements for MolDX: IKBKAP Genetic Testing.
MolDX: KIF6 Genotype Billing and Coding Guidelines [PDF] View coverage and billing requirements for KIF6 genotype testing.
MolDX: Know error Billing and Coding Guidelines Update [PDF] View updated coverage and billing requirements for MolDX: Know error.
MolDX: L1CAM Gene Sequencing Billing and Coding Guidelines [PDF] View coverage and billing requirements for MolDX: L1CAM Gene Sequencing.
MolDX: LPA-Aspirin Genotype Billing and Coding Guidelines [PDF] View coverage and billing requirements for MolDX: LPA-Asprin Genotype testing.
MolDX: LPA-Intron 25 Genotype Billing and Coding Guidelines [PDF] View coverage and billing requirements for MolDX: LPA-Intron 25 Genotype testing.
MolDX: MCOLN1 Genetic Testing Billing and Coding Guidelines [PDF] There is insufficient evidence to support the required clinical utility for the established Medicare benefit category.
MolDX: MECP2 Genetic Testing Billing and Coding Guidelines [PDF] View coverage and billing requirements for MECP2 Genetic Testing.
MolDX: Microsatellite Instability-High (MSI-H) and Mismatch Repair Deficient (dMMR) Biomarker Billing and Coding Guidelines for Patients with Unresectable or Metastatic Solid Tumors [PDF] View coverage and billing requirements for MolDX: MSI-H and dMMR Biomarker Billing and Coding Guidelines for Patients with Unresectable or Metastatic Solid Tumors.
MolDX: Mitochondrial Nuclear Gene Tests Billing and Coding Guidelines [PDF] View updated coverage and billing requirements for MolDX: Mitochondrial Nuclear Gene Tests.
MolDX: MMACHC Test Billing and Coding Guidelines [PDF] View billing and coding guidelines for MolDX: MMACHC testing
MolDX: myPap Billing and Coding Guidelines Update [PDF] View updated coverage and billing requirements for MolDX: myPap Tests.
MolDX: NSD1 Gene Tests Billing and Coding Guidelines [PDF] View coverage and billing requirements for MolDX: NSD1 Gene Tests.
MolDX: OncoCee Billing and Coding Guidelines [PDF] View updated coverage and billing requirements for MolDX: OncoCee.
MolDX: Oncotype DX® Genomic Prostate Score Coding and Billing Article [PDF] View coding and billing requirements for Oncotype DX® Genomic Prostate Score Testing
MolDX: PAX6 Gene Sequencing Billing and Coding Guidelines [PDF] View billing and coding guidelines for MolDX: PAX6 Gene Sequencing
MolDX: PIK3CA Gene Tests Billing and Coding Guidelines [PDF] View coverage and billing requirements for MolDX: PIK3CA Gene Tests.
MolDX: PreDx® Billing and Coding Guidelines [PDF] View coverage and billing requirements for MolDX: PreDx®.
MolDX: PTCH1 Gene Testing Billing and Coding Guidelines [PDF] View coverage and billing requirements for MolDX: PTCH1 Gene Testing.
MolDX: RPS19 Gene Tests Billing and Coding Guidelines [PDF] View coverage and billing requirements for MolDX: RPS19 Gene Tests.
MolDX: SETP9 Gene Test Billing and Coding Guidelines [PDF] View billing and coding guidelines for MolDX: SETP9 Gene Tests
MolDX: SLCO1B1 Genotype Billing and Coding Guidelines [PDF] To date, there is insufficient evidence to support the required clinical utility for the established Medicare benefit category. Therefore, the SLCO1B1 genotype test is a statutorily excluded service.
MolDX: SMPD1 Genetic Testing Billing and Coding [PDF] MolDX has determined that SMPD1 genetic testing is not a Medicare benefit and is a statutorily excluded service. In addition to single disease testing, Noridian will also deny panels of tests that include a SMPD1 gene test as a statutorily excluded service.
MolDX: STAT3 Gene Testing Billing and Coding Guidelines [PDF] There is insufficient evidence to support the required clinical utility for the established Medicare benefit category.
MolDX: SULT4A1 Genetic Testing Billing and Coding Guidelines [PDF] View coverage and billing requirements for MolDX: SULT4A1 Genetic Testing.
MolDX: Targeted and Comprehensive Genomic Profile Next-Generation Sequencing Testing in Cancer [PDF] View coverage and billing requirements for Targeted and Comprehensive Genomic Profile Next-Generation Sequencing Testing in Cancer.
MolDX: TERC Gene Tests Billing and Coding Guidelines [PDF] View coverage and billing requirements for MolDX: TERC Gene Tests.
MolDX: TP53 Gene Test Billing and Coding Guidelines [PDF] View coverage and billing requirements for the TP53 Gene Test
MolDX: UGT1A1 Gene Analysis Billing and Coding Guidelines [PDF] There is insufficient evidence to support the required clinical utility for the established Medicare benefit category.
MolDX: VEGFR2 Tests Coding and Billing Guidelines [PDF] View coding and billing guidelines for MolDX: VEGFR2
Noncoverage of Peripheral Nerve Field Stimulation - Coding and Billing [PDF] View coverage and billing requirements for Noncoverage of Peripheral Nerve Field Stimulation – Coding and Billing.
Non-Payment for Prefabricated Splints [PDF] View coverage and billing guidelines for non-payment of prefabricated splints.
Outpatient Therapy Biofeedback Training [PDF] View Medicare coverage and billing of Outpatient Therapy Biofeedback Training. 
Parenteral Iron Administration Coverage in Non-Dialysis Usage [PDF] View coverage description for the Parenteral Iron Administration Coverage in Non-Dialysis Usage.
Patients Supplied Donated or Free-of-Charge Drug [PDF] View coverage and billing requirements for Patients Supplied Donated or Free-of-Charge Drug.
Pegfilgrastim (Neulasta) J2505 [PDF] View coverage and medical necessity guidelines for Pegfilgrastim (Neulasta) J2505 Coverage.
Peripheral Nerve Blocks Non-covered for the Treatment of Diabetic Peripheral Neuropathic Pain [PDF] View non-coverage description for Peripheral Nerve Blocks Non-covered for the Treatment of Diabetic Peripheral Neuropathic Pain.
Piriformis Injections [PDF] View coverage and billing requirements for Piriformis Injections Coverage.
Post Market Studies and Post Market Extension Studies - Percutaneous Transluminal Angioplasty (PTA) with Carotid Stenting and Embolic Protection View coverage and reimbursement information for specific "post-marketing studies" that may be approved by Medicare contractors. These studies all involve the use of percutaneous transluminal angioplasty (PTA) with carotid stenting and embolic protection.
Posterior Tibial Nerve Stimulation Coverage [PDF] View coverage and billing requirements for Posterior Tibial nerve Stimulation Coverage.
Pulmonary Rehabilitation Services [PDF] View coverage, coding and billing information for Pulmonary Rehabilitation Services defined by the SSA, NCD and CMS manuals, including contractor determined coding criteria.
Reporting a Non-Covered Test Performed in Preparation for a Non-Covered Procedure [PDF] When a diagnostic test is necessary for the performance of a non-covered service, that test typically may not be covered. Noridian wishes to remind providers to appropriately report this as a non-covered test, by submitting the code with a GY modifier.
Routine Dental Services [PDF] ICD-10-CM codes that are considered routine dental services and are non covered.
Sclerosing of Varicose Veins [PDF] View information regarding incorrect coding for CPT 37241 for varicose vein ablation.
Sipuleucel-T (Provenge®) - Coverage Criteria for Prostate Cancer - Clarification [PDF] View clarification for coverage criteria for Prostate Cancer
Sleep Lab Credentialing: Polysomnography and Other Sleep Studies [PDF] View Sleep Lab Credentialing for Polysomnography and Other Sleep Studies
Special Stains and Immunohistochemistry (IHC) Indications for Gastric Pathology [PDF] View coverage and billing requirements for Special Stains and Immunohistochemistry (IHC) Indications for Gastric Pathology.
Spinal Fusion Services: Documentation Requirements [PDF] View clarification of medical necessity and documentation requirements.
Testopel Coverage [PDF] View coverage guidelines for Testopel pellets.
Therapeutic Apheresis for Familial Hypercholesterolemia [PDF] View coverage information for therapeutic apheresis in the treatment of refractory familial hypercholesterolemia.
Therapy Driving Evaluations [PDF] View Medicare coverage and billing guide for Therapy Driving Evaluations.
Therapy Evaluation and Assessment Services [PDF] View coverage and billing requirements for Therapy Evaluation and Assessment Services Coverage.
Therapy Evaluation Coding [PDF] View coverage and billing requirements for Therapy Evaluation Coding Coverage.
Therapy Students and Aides [PDF] View coverage and billing requirements for Therapy Students and Aides Coverage.
Topical HBO and Physician Related Service Billing and Coding Guidelines [PDF] View coverage and billing requirements for Topical HBO and Physician Related Service Billing and Coding Guidelines
Treatment with Yttrium-90 Microspheres [PDF] View coverage and billing requirements for Yttrium-90 Microspheres.
Use of Amniotic Membrane Derived Skin Substitutes [PDF] Clinical use of amniotic membrane derived skin substitutes outside of the care of DSU and VSU as not reasonable and necessary and non-covered.
Waiver of Face-to-Face Visit for Home Dialysis Patients – Coding and Billing [PDF] View coding guidelines to request waiver with 52 modifier to the appropriate monthly capitation CPT codes 90963-90966.
Wound Care & Debridement-Provided by a Therapist, Physician, NPP or as Incident-to Services [PDF] View coverage and billing requirements for Wound Care & Debridement – Provided by a Therapist, Physician, NPP or as Incident-to Services Coverage.
Zika Virus Testing by PCR and ELISA Methods [PDF] View Zika Virus billing and coverage information


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Last Updated Nov 14, 2019