Medicare Coverage Articles - JE Part A
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 | Article Number | CPT/HCPCS Codes Referenced |
|---|---|---|
| Billing and Coding: Abbreviated Daytime Sleep Study (e.g. PAP-NAP) | A55478 | N/A |
| Billing and Coding: Allergy Testing | A57181 | 86003, 86005, 95004, 95017, 95018, 95024, 95027, 95028, 95044, 95052, 95056, 95060, 95065, 95070, 95076, 95079 |
| Billing and Coding: Arthroscopic Lavage and Arthroscopic Debridement for Osteoarthritic Knees | A54061 | 29871 |
| Billing and Coding: Artificial Hearts and Percutaneous Endovascular Cardiac Assist Procedures and Devices | A52966 | 33927, 33928, 33929, 33990, 33991, 33995, 33997 |
| Billing and Coding: Bariatric Surgery Coverage | A53026 | 43644, 43645, 43770, 43775, 43845, 43846, 43847 |
| Billing and Coding: Billing Limitations for Pharmacies | A56119 | 90630, 90653, 90654, 90655, 90656, 90657, 90658, 90660, 90661, 90662, 90664, 90666, 90667, 90668, 90670, 90672, 90673, 90674, 90682, 90685, 90686, 90687, 90688, 90689, 90732, 90756, G0008, G0009, J7170, J7180, J7181, J7182, J7183, J7185, J7186, J7187, J7188, J7189, J7190, J7191, J7192, J7193, J7194, J7195, J7198, J7199, J7200, J7201, J7202, J7205, J7212, J7214 |
| Billing and Coding: Billing Medicare for the SphenoCath and Other Similar Devices | A55584 | 64999 |
| Billing and Coding: Chiropractic Services | A57913 | 98940, 98941, 98942 |
| Billing and Coding: Dental Services | A59447 | N/A |
| Billing and Coding: Fracture Care | A53322 | N/A |
| Billing and Coding: Guardant360® | A58192 | 81479 |
| Billing and Coding: Home PT/INR Monitoring (G0249) Billing and Coding | A55754 | G0249 |
| Billing and Coding: Hydration Services | A54635 | 96360, 96361 |
| Billing and Coding: Implantable Automatic Defibrillators | A56340 | 33202, 33203, 33215, 33216, 33217, 33218, 33220, 33223, 33224, 33225, 33230, 33231, 33240, 33241, 33243, 33244, 33249, 33262, 33263, 33264, 33270, 33271, 33272, 33273, C7537, C7538, C7539, C7540, G0448 |
| Billing and Coding: Implantable Infusion Pumps for Chronic Pain | A55239 | 62325, 62327, 62350, 62351, 62355, 62360, 62361, 62362, 62365, 62367, 62368, 62369, 62370, 95990, 95991, J7999 |
| Billing and Coding: Incident To Clarification for OPPS and CAH Outpatient | A55215 | N/A |
| Billing and Coding: Influenza Diagnostic Tests | A59055 | 87252, 87253, 87254, 87275, 87286, 87400, 87501, 87502, 87503, 87804 |
| Billing and Coding: Intensity Modulated Radiation Therapy (IMRT) | A58236 | 77385, 77386, G6015, G6016 |
| Billing and Coding: Intraocular Bevacizumab | A53008 | 67028, 92134, C9257, J7999, Q5129 |
| Billing and Coding: IUD (Hormone-Eluting) for Endometrial Hyperplasia - CPT 58999 | A55061 | 58999 |
| Billing and Coding: JW and JZ Modifier Billing Guidelines | A53024 | N/A |
| Billing and Coding: Medical Necessity of Therapy Services | A53304 | 97161, 97162, 97163, 97165, 97166, 97167 |
| Billing and Coding: MolDX: 4q25-AF Risk Genotype | A55090 | 81479 |
| Billing and Coding: MolDX: 9p21 Genotype Test | A55092 | 81479 |
| Billing and Coding: MolDX: Aspartoacyclase 2 Deficiency (ASPA) Testing | A55088 | 81200, 81412, 81443, 81479 |
| Billing and Coding: MolDX: ATP7B Gene Tests | A55097 | 81406, 81443, 81479 |
| Billing and Coding: MolDX: BCKDHB Gene Test | A55099 | 81205, 81406, 81443 |
| Billing and Coding: MolDX: BLM Gene Analysis | A55113 | 81209, 81443 |
| Billing and Coding: MolDX: BluePrint® | A55115 | 81479 |
| Billing and Coding: MolDX: CDH1 Genetic Testing | A55970 | 81406 |
| Billing and Coding: MolDX: CHD7 Gene Analysis | A55085 | 81407, 81479 |
| Billing and Coding: MolDX: ENG and ACVRL1 Gene Tests | A55181 | 81405, 81406, 81479 |
| Billing and Coding: MolDX: FANCC Genetic Testing | A55183 | 81242, 81412, 81443 |
| Billing and Coding: MolDX: FDA Approved CLL Companion Diagnostic Test | A56009 | 88271, 88275, 88291, 88374, 88377 |
| Billing and Coding: MolDX: Fragile X | A55241 | 81243, 81244, 81470, 81471 |
| Billing and Coding: MolDX: GBA Genetic Testing | A55243 | 81251 |
| Billing and Coding: MolDX: HAX1 Gene Sequencing | A55249 | 81479 |
| Billing and Coding: MolDX: HBB Gene Tests | A55253 | 81361, 81362, 81363, 81364, 81443 |
| Billing and Coding: MolDX: HEXA Gene Analysis | A55255 | 81255, 81406, 81412, 81443 |
| Billing and Coding: MolDX: HLA Testing for Transplant Histocompatibility | A57970 | 81370, 81371, 81372, 81373, 81375, 81376, 81378, 81379, 81380, 81382 |
| Billing and Coding: MolDX: HTTLPR Gene Testing | A55264 | 81479 |
| Billing and Coding: MolDX: IKBKAP Genetic Testing | A55612 | 81260, 81412, 81443 |
| Billing and Coding: MolDX: KIF6 Genotype | A55272 | 81479 |
| Billing and Coding: MolDX: Know Error | A55274 | 84999 |
| Billing and Coding: MolDX: L1CAM Gene Sequencing | A55277 | 81407, 81470, 81471 |
| Billing and Coding: MolDX: LPA-Aspirin Genotype | A55279 | 81479 |
| Billing and Coding: MolDX: LPA-Intron 25 Genotype | A55281 | 81479 |
| Billing and Coding: MolDX: MCOLN1 Genetic Testing | A55283 | 81290, 81412, 81443 |
| Billing and Coding: MolDX: MECP2 Genetic Testing | A55285 | 81302, 81303, 81304, 81470, 81471, 81479 |
| Billing and Coding: MolDX: Mitochondrial Nuclear Gene Tests | A55290 | 81479 |
| Billing and Coding: MolDX: MMACHC Test | A55288 | 81404 |
| Billing and Coding: MolDX: myPap | A55292 | 84999 |
| Billing and Coding: MolDX: NSD1 Gene Tests | A55609 | 81405, 81406, 81479 |
| Billing and Coding: MolDX: PAX6 Gene Sequencing | A55625 | 81479 |
| Billing and Coding: MolDX: PIK3CA Gene Tests | A55597 | 81309, 0155U |
| Billing and Coding: MolDX: PTCH1 Gene Testing | A55608 | 81479 |
| Billing and Coding: MolDX: RPS19 Gene Tests | A55610 | 81405, 81479 |
| Billing and Coding: MolDX: SEPT9 Gene Test | A55623 | 81327 |
| Billing and Coding: MolDX: SMPD1 Genetic Testing | A55627 | 81330, 81412 |
| Billing and Coding: MolDX: STAT3 Gene Testing | A55480 | 81405 |
| Billing and Coding: MolDX: SULT4A1 Genetic Testing | A55596 | 81479 |
| Billing and Coding: MolDX: TERC Gene Tests | A55611 | 81479 |
| Billing and Coding: MolDX: Testing of Multiple Genes | A58120 | N/A |
| Billing and Coding: MolDX: TP53 Gene Test Billing and Coding Guidelines | A55484 | 81351, 81352 |
| Billing and Coding: MolDX: VEGFR2 Tests | A55468 | 81479 |
| Billing and Coding: Outpatient Therapy Biofeedback Training | A53352 | 90901, 90912, 90913 |
| Billing and Coding: Patients Supplied Donated or Free-of-Charge Drug | A55044 | N/A |
| Billing and Coding: Physician Supervision of Dialysis for Acute Kidney Injury | A55992 | 90935, 90937, 90945, 90947 |
| Billing and Coding: Piriformis Injections | A56027 | 20552 |
| Billing and Coding: Positron Emission Tomography Scans Coverage | A54666 | 78429, 78430, 78431, 78432, 78433, 78434, 78459, 78491, 78492, 78608, 78609, 78811, 78812, 78813, 78814, 78815, 78816, A4641, A9515, A9526, A9552, A9555, A9580, A9586, A9587, A9588, A9591, A9592, A9593, A9594, A9595, A9596, A9597, A9598, A9602, A9800, G0235, Q9982, Q9983 |
| Billing and Coding: Posterior Tibial Nerve Stimulation Coverage | A55104 | 64566, 0587T, 0588T, 0589T, 0590T |
| Billing and Coding: Pulmonary Function Testing | A57216 | 94010, 94011, 94012, 94013, 94060, 94070, 94150, 94200, 94375, 94450, 94617, 94618, 94619, 94621, 94640, 94664, 94680, 94681, 94690, 94726, 94727, 94728, 94729 |
| Billing and Coding: Pulmonary Rehabilitation Services | A56152 | 94625, 94626, G0237, G0238, G0239 |
| Billing and Coding: Remote Imaging of the Retina to Screen for Retinal Diseases | A58384 | 92227, 92228, 92229 |
| Billing and Coding: Reporting a Non-Covered Test Performed in Preparation for a Non-Covered Procedure | A55774 | 92025 |
| Billing and Coding: Routine Foot Care | A57954 | 11055, 11056, 11057, 11719, 11720, 11721, G0127 |
| Billing and Coding: Sacral Nerve Stimulation for Urinary and Fecal Incontinence | A53359 | 64561, 64581, 64585, 64590, 64595, A4290, C1767, C1778, C1820, C1883, C1897, L8680 |
| Billing and Coding: Short Tandem Repeat (STR) Markers and Chimerism (CPT® codes 81265-81268) | A57842 | 81265, 81266, 81267, 81268 |
| Billing and Coding: Single Chamber and Dual Chamber Permanent Cardiac Pacemakers - Coding and Billing | A54929 | 33206, 33207, 33208 |
| Billing and Coding: Spinal Fusion Services: Documentation Requirements | A53972 | N/A |
| Billing and Coding: Spinraza® (Nusinersen) | A58578 | J2326 |
| Billing and Coding: Therapy Driving Evaluations | A53292 | N/A |
| Billing and Coding: Therapy Evaluation Coding | A55371 | N/A |
| Billing and Coding: Therapy Evaluation, Re-Evaluation and Formal Testing | A53309 | 95851, 95852, 97161, 97162, 97163, 97164, 97165, 97166, 97167, 97168, 97750 |
| Billing and Coding: Therapy Students and Aides | A53339 | N/A |
| Billing and Coding: Tomosynthesis-Guided Breast Biopsy | A57848 | 19081, 19082, 19083, 19084, 19085, 19086, 19100, 19101, 19281, 19282, 19283, 19284, 19285, 19286, 19287, 19288, 19499, 76098, 76376, 76377, 77011, 77053, 77054, 77061, 77062, 77063, 77065, 77066, 77067, C7501, C7502, G0279 |
| Billing and Coding: Topical HBO and Physician Related Service Billing and Coding Guidelines | A56025 | 99199, A4575, E0446 |
| Billing and Coding: Treatment with Yttrium-90 Microspheres | A54072 | C2616, Q3001 |
| Billing and Coding: Wound Care & Debridement-Provided by a Therapist, Physician, NPP or as Incident-to Services | A53296 | 29580, 97022, 97161, 97162, 97153, 97597, 97598, 97602, G0463 |
| Billing and Coding: Zika Virus Testing by PCR and ELISA Methods | A55326 | 86790, 86794, 87662, 87798, 87801 |
| Dropless Cataract Surgery | A53916 | N/A |
| Investigational Device Exemptions(IDE) - IDE Documentation Requirements for Studies with an FDA Approval dated January 01, 2015 or Later | A54919 | N/A |
| Lymphedema Decongestive Treatment | A55710 | 29581, 29584, 97140, 97535 |
| MolDX: Algorithm definition as a component of a laboratory test | A58673 | N/A |
| Non-Payment for Prefabricated Splints | A56112 | N/A |
| Parenteral Iron Administration Coverage in Non-Dialysis Usage | A55653 | N/A |
| Pegfilgrastim (Neulasta) J2505 | A52889 | N/A |
| Post Market Studies and Post Market Extension Studies - Percutaneous Transluminal Angioplasty (PTA) with Carotid Stenting and Embolic Protection | N/A | N/A |
| Sipuleucel-T (Provenge®) - Coverage Criteria for Prostate Cancer - Clarification | A55719 | Q2043 |
| Sterilization | A53356 | 55250, 58600, 58605, 58611, 58615, 58670, 58671 |
| Therapeutic Apheresis for Familial Hypercholesterolemia | A54543 | 36516 |
| Waiver of Face-to-Face Visit for Home Dialysis Patients | A55058 | N/A |
To view all the articles on the CMS website, select a link below to be redirected to the MCD.
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Last Updated Thu, 21 Sep 2023 18:33:28 +0000