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.

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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: Arthroscopic Lavage and Arthroscopic Debridement for Osteoarthritic Knees A54061 29871
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: 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: 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: Proteomics Testing A59641 81490, 81500, 81503, 81517, 81539, 81599, 0002M, 0003M, 0015M, 0019M, 0002U, 0003U, 0021U, 0080U, 0092U, 0095U, 0105U, 0117U, 0174U, 0206U, 0207U, 0228U, 0249U, 0259U, 0263U, 0295U, 0308U, 0309U, 0310U, 0312U, 0322U, 0344U, 0351U, 0360U, 0365U, 0366U, 0367U, 0375U, 0384U, 0385U, 0387U, 0407U, 0415U, 0436U
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: Piriformis Injections A56027 20552
Billing and Coding: Pulmonary Rehabilitation Services A56152 94625, 94626, G0237, G0238, G0239
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: 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
MolDX: Defining panel services in MolDX A59685 N/A
Non-Payment for Prefabricated Splints A56112 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

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Last Updated Mar 08 , 2024