Article Detail - JE Part B

Date Posted: June 7, 2024

This coverage article has been created and published for notice under contract numbers: 01112 (NCA), 01182 (SCA), 01212 (AS, GU, HI, NMI), and 01312 (NV).

Effective Date: June 6, 2024

Summary of Article: The CMS A/B Medicare Administrative Contractor’s (MAC’s) responsibility is to ensure compliance with Medicare National Coverage Determinations (NCDs) at the local jurisdictional level. Upon review of claim sampling, Noridian has observed errors in billing and coding for items/services discussed in NCD 20.8.4 Leadless Pacemakers, which became effective January 18, 2017. While most providers are following NCD coverage requirements, at the time of this instruction, Noridian has identified CPT/HCPCs codes that require updating as well as a few new CPT/HCPCs codes representing leadless pacemakers that would fall under the same NCD requirements. As a result, Noridian finds it important to provide additional billing and coding guidance to assist providers in meeting the requirements set forth by this NCD as well as to supplement information provided in the Medicare Claims Processing Manual (MCPM), Chapter 32, Section 380. While this guidance is considered effective, Noridian will continue to review claims by individual consideration for the immediate future to accommodate billing and coding adjustments by providers and/or billers and coders. However, as a reminder, this NCD has been effective since 2017 and is not considered a new coverage policy.

Visit the Noridian Billing and Coding Articles webpage to view the complete listing of coverage articles and/or access the Active, Future, or Retired articles available in the CMS MCD.