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Medicare Coverage Articles

The term "article" is used to describe any bulletin article, web site 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) 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 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.
Coenzyme Q10 (Q10) Coding and Billing Guideline [PDF] View Coding and Billing Guidelines for Coenzyme (CoQ10)
Dropless Cataract Surgery View coverage and billing information for Dropless Cataract Surgery.
HemoDialysis Frequency [PDF] View billing, documentation, and coding requirements for coverage and payment of additional hemodialysis sessions.
High Compression Bandage System Clarification 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 View coverage and billing requirements for Hydration Services Coverage.
Implantable Infusion Pumps for Chronic Pain View information regarding implanted Infusion Pumps for Chronic pain and Compounded Drugs
Incident To Clarification for OPPS and CAH Outpatient View key points related to "incident to" regulations in an outpatient hospital setting
Injectable Bulking Agents for the Treatment of Fecal Incontinence View billing and manual review notice for medical ncessity and reasonableness for this procedure.

Intraocular Bevacizumab Coding/Billing Guidelines [PDF]

View coverage and billing requirements for off-label use of bevacizumab for intravitreal injection.
Investigational Device Exemptions (IDEs) 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 View appropriate ICD-10 CM diagnoses for endometrial hyperplasia and use of CPT 58999.
Medical Necessity of Therapy Services View coverage and billing requirements for Medical Necessity of Therapy Services Coverage.
MolDX: BCR-ABL Billing and Coding Guidelines [PDF] View coverage and billing requirements for MolDX: BCR-ABL.
MolDX: Bladder Tumor Marker FISH Billing and Coding Guidelines [PDF] View coverage and billing requirements for MolDX: Bladder Tumor Marker FISH Billing and Coding Guidelines.
MolDX: FDA Approved ALK Companion Diagnostic Tests Billing and Coding Guidelines View billing and coding guidelines for MolDX: FDA approved ALK testing
MolDX: HBB Gene Tests Billing and Coding Guidelines [PDF] View coverage and billing requirements for MolDX: HBB Gene Tests.
MolDX: IKBKAP Genetic Testing Billing and Coding Guidelines View coverage and billing requirements for MolDX: IKBKAP Genetic 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 View coverage and billing requirements for MolDX: L1CAM Gene Sequencing.
MolDX: Mitochondrial Nuclear Gene Tests Billing and Coding Guidelines [PDF] View updated coverage and billing requirements for MolDX: Mitochondrial Nuclear Gene Tests.
MolDX: myPap Billing and Coding Guidelines Update [PDF] View updated coverage and billing requirements for MolDX: myPap Tests.
MolDX: Myriad's BRACAnalysis CDx™ Billing and Coding Guidelines View coverage and billing requirements for MolDX: Myriad's BRACAnalysis CDx™ .
MolDX: NSD1 Gene Tests Billing and Coding Guidelines 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: MCOLN1 Genetic Testing Billing and Coding Guidelines There is insufficient evidence to support the required clinical utility for the established Medicare benefit category.
MolDX: MMACHC Test Billing and Coding Guidelines View billing and coding guidelines for MolDX: MMACHC testing
MolDX: PIK3CA Gene Tests Billing and Coding Guidelines 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 View coverage and billing requirements for MolDX: PTCH1 Gene Testing.
MolDx: ResponseDX Tissue of Origin® Billing and Coding Guidelines [PDF] View coverage and billing requirements for MolDx: ResponseDX Tissue of Origin®.
MolDX: RPS19 Gene Tests Billing and Coding Guidelines View coverage and billing requirements for MolDX: RPS19 Gene Tests.
MolDX: STAT3 Gene Testing Billing and Coding Guidelines There is insufficient evidence to support the required clinical utility for the established Medicare benefit category.
MolDX: SULT4A1 Genetic Testing Billing and Coding Guidelines View coverage and billing requirements for MolDX: SULT4A1 Genetic Testing.
MolDX: TERC Gene Tests Billing and Coding Guidelines View coverage and billing requirements for MolDX: TERC Gene Tests.
MolDX: UGT1A1 Gene Analysis Billing and Coding Guidelines There is insufficient evidence to support the required clinical utility for the established Medicare benefit category.
MolDX: VEGFR2 Tests Coding and Billing Guidelines View coding and billing guidelines for MolDX: VEGFR2
Outpatient Therapy Biofeedback Training 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.
Pegfilgrastim (Neulasta) J2505 View coverage and medical necessity guidelines for Pegfilgrastim (Neulasta) J2505 Coverage.
Peripheral Nerve Blocks Non-covered for the Treatment of Diabetic Peripheral Neuropathy View non-coverage description for peripheral nerve blocks.
Post Market Studies and Post Market Extension Studies 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 View coverage and billing requirements for Posterior Tibial nerve Stimulation Coverage.
Qutenza 8% Patch Billing and Coverage View instructions on billing and coverage for Qutenza
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.
Response to Comments: MolDX: APC and MUTYH View comments and responses to draft LCD
Routine Dental Services [PDF] ICD-10-CM codes that are considered routine dental services and are non covered.
Sclerosing of Varicose Veins 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 View Sleep Lab Credentialing for Polysomnography and Other Sleep Studies
Testopel Coverage View coverage guidelines for Testopel pellets.
Therapeutic Apheresis for Familial Hypercholesterolemia View coverage information for therapeutic apheresis in the treatment of refractory familial hypercholesterolemia.
Therapy Driving Evaluations View Medicare coverage and billing guide for Therapy Driving Evaluations.
Therapy Evaluation and Assessment Services View coverage and billing requirements for Therapy Evaluation and Assessment Services Coverage.
Therapy Evaluation Coding View coverage and billing requirements for Therapy Evaluation Coding Coverage.
Therapy Students and Aides View coverage and billing requirements for Therapy Students and Aides Coverage.
Treatment with Yttrium-90 Microspheres View coverage and billing requirements for Yttrium-90 Microspheres.
Waiver of Face-to-Face Visit for Home Dialysis Patients – Coding and Billing 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 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


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 Dec 15, 2017