Policies

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 Brief Description
Billing and Coding for Pathology Services on the Same Date of Service (DOS) as Mohs Surgery A56514 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: Abbreviated Daytime Sleep Study (e.g. PAP-NAP) A55479 View coverage and billing requirements for Abbreviated Daytime Sleep Studies.
Billing and Coding: Allergy Testing A57181 View coverage and billing requirements for Allergy Testing Policy.
Billing and Coding: Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin's and Non-Hodgkin's Lymphoma with B-cell or T-cell Origin A59175 View coverage and billing requirements for Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin's and Non-Hodgkin's Lymphoma with B-cell or T-cell Origin
Billing and Coding: Arthroscopic Lavage and Arthroscopic Debridement for Osteoarthritic Knees A54061 View Coverage and Billing requirements for Arthroscopic Lavage and Arthroscopic Debridement for Osteoarthritic Knees
Billing and Coding: Artificial Hearts and Percutaneous Endovascular Cardiac Assist Procedures and Devices A52966 View coverage and billing requirements for Artificial Hearts and Percutaneous Endovascular Cardiac Assist Procedures and Devices.
Billing and Coding: B-type Natriuretic Peptide (BNP) Testing A57083 View billing and coding requirements for B-type Natriuretic Peptide (BNP) Testing Policy.
Billing and Coding: Bariatric Surgery Coverage A53026 View Coverage and Billing requirements for Bariatric Surgery Coverage
Billing and Coding: Benign Skin Lesion Removal (Excludes Actinic Keratosis and MOHS) A57161 View billing and coding requirements for the Benign Skin Lesion Removal (Excludes Actinic Keratosis and MOHS LCD.
Billing and Coding: Billing Limitations for Pharmacies A56119 View coverage and billing requirements for Billing Limitations for Pharmacies Coverage.
Billing and Coding: Billing Medicare for the SphenoCath and Other Similar Devices A55584 View coverage and billing requirements for Billing Medicare for the SphenoCath® Device Coverage.
Billing and Coding: Blepharoplasty, Eyelid Surgery, and Brow Lift A57190 View billing and coding requirements for Blepharoplasty, Eyelid Surgery, and Brow Lift Policy.
Billing and Coding: Botulinum Toxin Types A and B Policy A57185 View billing and coding requirements for Botulinum Toxins Types A and B Policy.
Billing and Coding: Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography A57183 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 A57195 View billing and coding requirements for Cataract Surgery in Adults Policy.
Billing and Coding: Chest X-Ray A57497 View billing and coding requirements for Chest X-Ray Policy.
Billing and Coding: Chiropractic Services A57913 View billing and coding requirements for Chiropractic Services.
Billing and Coding: Colon Capsule Endoscopy A58436 View coverage and billing requirements for Colon Capsule Endoscopy
Billing and Coding: Complex Drug Administration Coding A58532 View coverage and billing requirements for Billing and Coding: Complex Drug Administration Coding Coverage.
Billing and Coding: Computed Tomography Cerebral Perfusion Analysis (CTP) A58223 View billing and coding requirements for Computed Tomography Cerebral Perfusion Analysis (CTP).
Billing and Coding: Coverage of Intravenous Immune Globulin for Treatment of Primary Immune Deficiency Diseases in the Home - Medicare Benefit Policy Manual, Chapter 15, 50.6 A54660 View coverage and billing requirements for IVIG for Treatment of Primary Immune Deficiency Diseases in the Home.
Billing and Coding: Diagnostic and Therapeutic Colonoscopy A57342 View billing and coding requirements for Diagnostic and Therapeutic Colonoscopies.
Billing and Coding: Electrocardiograms A57326 View billing and coding requirements for Electrocardiogram LCD.
Billing and Coding: Epidural Steroid Joint Injections for Pain Management A58993 View coverage and billing requirements for Billing and Coding Epidural Steroid Joint Injections LCD.
Billing and Coding: Facet Joint Interventions for Pain Management A58403 View billing and coding requirements for Billing and Coding: Facet Joint Interventions for Pain Management LCD.
Billing and Coding: Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification Tests (NAATs) A56706 View billing and coding requirements for Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification Tests (NAATS) LCD.
Billing and Coding: Fracture Care Coding for Physicians A53322 Many times the initial treating physician does not provide all of the follow-up care after surgery. View examples of acceptable ways to bill for definitive or restorative treatment of a fracture.
Billing and Coding: Frequency of Hemodialysis A55675 View coding and billing requirements for Hemodialysis Sessions.
Billing and Coding: GlycoMark Testing for Glycemic Control A57237 View billing and coding requirements for GlycoMark testing for glycemic control.
Billing and Coding: Guardant360® A58192 View billing and coding requirements for Guardant360®.
Billing and Coding: High Compression Bandage System Clarification A53287 View coverage and billing requirements for High Compression Bandage System Clarification Coverage.
Billing and Coding: HLA-DQB1*06:02 Testing for Narcolepsy A57441 View billing and coding requirements for the HLA-DQB1*06:02 Testing for Narcolepsy LCD.
Billing and Coding: Home PT/INR Monitoring (G0249) Billing and Coding A55754 View coding and billing guidance as it relates to the NCD for Home Prothrombin Time/International Normalized Ration Monitoring for Anticoagulation Monitoring.
Billing and Coding: Hydration Services A54635 View coverage and billing requirements for Hydration Services Coverage.
Billing and Coding: Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea A57948 View billing and coding Guidelines for Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea.
Billing and Coding: Immune Globulin Intravenous (IVIg) A57187 View billing and coding requirements for the Immune Globulin Intravenous (IVIg) LCD.
Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM) A58133 View billing and coding guidelines for Implantable Continuous Glucose Monitors.
Billing and Coding: Implantable Infusion Pumps for Chronic Pain A55239 View information regarding implanted Infusion Pumps for Chronic pain and Compounded Drugs.
Billing and Coding: In Vitro Chemosensitivity & Chemoresistance Assays A56071 View non-coverage and billing requirements for In Vitro Chemosensitivity Assays-Billing and Coding Guidelines.
Billing and Coding: Incident To Clarification for OPPS and CAH Outpatient A55215 View key points related to "incident to" regulations in an outpatient hospital setting.
Billing and Coding: Influenza Diagnostic Tests A59055 View Coverage and Billing requirements for Billing and Coding: Influenza Diagnostic Tests
Billing and Coding: Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma A57079 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) A58236 View billing and coding requirements for Intensity Modulated Radiation Therapy (IMRT) services.
Billing and Coding: Intraocular Bevacizumab A53008 View coverage and billing requirements for off-label use of bevacizumab for intravitreal injection.
Billing and Coding: IUD (Hormone-Eluting) for Endometrial Hyperplasia - CPT 58999 A55061 View appropriate ICD-10 CM diagnoses for endometrial hyperplasia and use of CPT 58999.
Billing and Coding: JW Modifier Billing Guidelines A53024 View coverage and billing requirements for Billing and Coding: JW Modifier Billing Guidelines article.
Billing and Coding: Lab: Bladder/Urothelial Tumor Markers A55028 View billing and coding requirements for Lab: Bladder/Urothelial Tumor Markers LCD.
Billing and Coding: Lab: Coenzyme Q10 (CoQ10) A55769 View billing and coding requirements for Lab: Coenzyme Q10 (CoQ10) LCD.
Billing and Coding: Lab: Controlled Substance Monitoring and Drugs of Abuse Testing A55001 View billing and coding requirements for Lab: Controlled Substance Monitoring and Drugs of Abuse Testing Policy.
Billing and Coding: Lab: Flow Cytometry A57689 View billing and coding requirements for Flow Cytometry LCD.
Billing and Coding: Lab: Special Histochemical Stains and Immunohistochemical Stains A57611 View billing and coding requirements for the Lab: Special Histochemical Stains and Immunohistochemical Stains LCD.
Billing and Coding: Lab: Special Stains and Immunohistochemistry (IHC) Indications for Gastric Pathology A55802 View billing and coding requirements for IHC Indications for Gastric Pathology.
Billing and Coding: Lumbar MRI A57206 View billing and coding requirements for Lumbar MRI LCD.
Billing and Coding: Lymphedema Decongestive Treatment A55710 View coverage and billing requirements for Lymphedema Decongestive Treatment Coverage.
Billing and Coding: Magnetic-Resonance-Guided Focused Ultrasound Surgery (MRgFUS) for Essential Tremor A57512 View billing and coding requirements for Magnetic-Resonance-Guided Focused Ultrasound Surgery (MRgFUS) for Essential Tremor.
Billing and Coding: MDS FISH A57661 View billing and coding requirements for MDS FISH LCD.
Billing and Coding: Measurement of Salivary Hormones A57612 View billing and coding requirements for the Measurement of Salivary Hormones LCD.
Billing and Coding: Medical Necessity of Therapy Services A53304 View coverage and billing requirements for Medical Necessity of Therapy Services Coverage.
Billing and Coding: Micro-Invasive Glaucoma Surgery (MIGS) A57863 View billing and coding requirements for Micro-Invasive Glaucoma Surgery (MIGS) LCD.
Billing and Coding: Mohs Micrographic Surgery A56514 View billing and coding requirements for Mohs Micrographic Surgery LCD.
Billing and Coding: MolDX: 4K Score Assay A57336 View billing and coding requirements for the MolDX: 4K Score Assay LCD.
Billing and Coding: MolDX: 4q25-AF Risk Genotype A55090 View billing and coding requirements for 4q25-AF Risk Genotype testing.
Billing and Coding: MolDX: 9p21 Genotype Test A55092 View billing and coding requirements for 9p21 Genotype testing.
Billing and Coding: MolDX: Abbott RealTime IDH2 testing for Acute Myeloid Leukemia (AML) A55711 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 A54356 View billing and coding requirements for the Afirma Assay by Veracyte.
Billing and Coding: MolDX: AlloMap A54364 View billing and coding requirements for the Allomap testing.
Billing and Coding: MolDX: Allosure® or Equivalent Cell-Free DNA Testing for Kidney and Heart Allografts A57380 View billing and coding requirements for Allosure® or Equivalent cell-free DNA.
Billing and Coding: MolDX: APC and MUTYH Gene Testing A57352 View billing and coding requirements for the MolDX: APC and MUTYH Gene Testing LCD.
Billing and Coding: MolDX: ApoE Genotype Billing and Coding Guidelines A55094 View coverage and billing guidelines for ApoE Genotype testing.
Billing and Coding: MolDX: Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C) Testing A54975 View billing and coding requirements for Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C) Testing.
Billing and Coding: MolDX: Aspartoacyclase 2 Deficiency (ASPA) Testing A55088 View billing and coding requirements for Aspartoacyclase 2 Deficiency (ASPA) Testing.
Billing and Coding: MolDX: ATP7B Gene Tests A55097 View billing and coding requirements for ATP7B gene testing.
Billing and Coding: MolDX: BCKDHB Gene Test A55099 View billing and coding requirements for BCKDHB Gene Testing.
Billing and Coding: MolDX: BCR-ABL A55595 View billing and coding requirements for MolDX: BCR-ABL.
Billing and Coding: MolDX: BDX-XL2 A57356 View billing and coding requirements for the MolDX: BDX-XL2 LCD.
Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment A57037 View billing and coding requirements for the LCD.
Billing and Coding: MolDX: bioTheranostics Cancer TYPE ID® A54386 View billing and coding requirements for the MolDX:bioTheranostics Cancer Type ID® LCD.
Billing and Coding: MolDX: BLM Gene Analysis A55113 View billing and coding requirements for BLM Gene Analysis.
Billing and Coding: MolDX: Blood Product Molecular Antigen Typing A57124 View billing and coding requirements for Blood Product Antigen typing.
Billing and Coding: MolDX: BluePrint® A55115 View billing and coding requirements for BluePrint®.
Billing and Coding: MolDX: BRCA1 and BRCA2 Genetic Testing A57354 View billing and coding requirements for the MolDX: BRCA1 and BRCA2 Genetic Testing LCD.
Billing and Coding: MolDX: Breast Cancer Assay: Prosigna A57363 View billing and coding requirements for the MolDX: Breast Cancer Assay: Prosigna LCD.
Billing and Coding: MolDX: Breast Cancer IndexTM (BCI) Gene Expression Test A57773 View billing and coding requirements for the MolDX: Breast Cancer IndexTM (BCI) Gene Expression Test LCD.
Billing and Coding: MolDX: CDH1 Genetic Testing Billing and Coding Guidelines A55970 View billing and coding requirements for MolDX CDH1 Genetic Testing.
Billing and Coding: MolDX: CHD7 Gene Analysis Coding and Billing Guidelines A55085 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.
Billing and Coding: MolDX: ConfirmMDx Epigenetic Molecular Assay A57605 View billing and coding requirements for the MolDX: ConfirmMDx Epigenetic Molecular Assay LCD.
Billing and Coding: MolDX: Cystatin C Measurement A57643 View billing and coding requirements for MolDX: Cystatin C Measurement LCD.
Billing and Coding: MolDX: DecisionDX-Melanoma A57417 View billing and coding requirements for the MolDX: DecisionDX-Melanoma LCD.
Billing and Coding: MolDX: DecisionDX-UM (Uveal Melanoma) A57621 View billing and coding requirements for the MolDX: DecisionDX-UM (Uveal Melanoma) LCD.
Billing and Coding: MolDX: EndoPredict® Breast Cancer Gene Expression Test A57607 View billing and coding requirements for the MolDX: EndoPredict® Breast Cancer Gene Expression Test LCD.
Billing and Coding: MolDX: ENG and ACVRL1 Gene Tests A55181 View billing and coding requirements for ENG and ACVRL1 Gene Tests.
Billing and Coding: MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test A57419 View billing and coding requirements for the MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test LCD.
Billing and Coding: MolDX: FANCC Genetic Testing A55183 View billing and coding guidelines for FANCC Genetic testing.
Billing and Coding: MolDX: FDA Approved CLL Companion Diagnostic Test A56009 View coverage and billing requirements for MolDX: FDA Approved CLL Companion Diagnostic Testing.
Billing and Coding: MolDX: FDA-Approved BRAF Tests A54418 View billing and coding requirements for FDA-Approved BRAF testing.
Billing and Coding: MolDX: FDA-Approved EGFR Tests A54422 View billing and coding requirements for the MolDX: FDA-Approved EGFR Tests LCD.
Billing and Coding: MolDX: FDA-Approved KRAS Tests A54498 View billing and coding requirements for the MolDX: FDA-Approved KRAS LCD.
Billing and Coding: MolDX: Fragile X Update A55241 View billing and coding requirements for Fragile X.
Billing and Coding: MolDX: GBA Genetic Testing A55243 View billing and coding requirements for Abbreviated Daytime Sleep Studies.
Billing and Coding: MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease A57421 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) A57423 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: Genetic Testing for Lynch Syndrome A54995 View coverage and billing requirements for Lynch Syndrome Testing.
Billing and Coding: MolDX: Germline testing for use of PARP inhibitors A55294 View billing and coding requirements for the MolDX: Germline testing for use of PARP inhibitors LCA.
Billing and Coding: MolDX: HAX1 Gene Sequencing A55249 View billing and coding requirements for HAX1 Gene Sequencing.
Billing and Coding: MolDX: HBB Gene Tests A55253 View billing and coding requirements for MolDX: HBB Gene Tests.
Billing and Coding: MolDX: HEXA Gene Analysis A55255 View billing and coding requirements for HEXA Gene Analysis.
Billing and Coding: MolDX: HLA Testing for Transplant Histocompatibility A57970 View coverage and billing requirement for Billing and Coding: MolDX: HLA Testing for Transplant Histocompatibility
Billing and Coding: MolDX: HTTLPR Gene Testing A55264 View billing and coding requirements for HTTLPR gene testing.
Billing and Coding: MolDX: IKBKAP Genetic Testing A55612 View billing and coding requirements for MolDX: IKBKAP Genetic Testing.
Billing and Coding: MolDX: Immunohistochemistry (IHC) Indication for Breast Pathology A57523 View billing and coding requirements for MolDX testing of Immunohistochemistry (IHC) Indications for Breast Pathology.
Billing and Coding: MolDX: Inivata, inVisionFirst, Liquid Biopsy for Patients with Lung Cancer A57664 View billing and coding requirements for MolDX: Inivata, InVisionFirst, Liquid Biopsy for Patients with Lung Cancer LCD.
Billing and Coding: MolDX: KIF6 Genotype A55272 View coverage and billing requirement for Billing and Coding: MolDX: KIF6 Genotype
Billing and Coding: MolDX: Know Error Update A55274 View updated billing and coding requirements for MolDX: Know error.
Billing and Coding: MolDX: L1CAM Gene Sequencing A55277 View coverage and billing requirements for MolDX: L1CAM Gene Sequencing.
Billing and Coding: MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer A58679 View coverage and billing requirements for MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer
Billing and Coding: MolDX: LPA-Aspirin Genotype A55279 View billing and coding requirements for MolDX: LPA-Asprin Genotype testing.
Billing and Coding: MolDX: LPA-Intron 25 Genotype A55281 View billing and coding requirements for MolDX: LPA-Intron 25 Genotype testing.
Billing and Coding: MolDX: MammaPrint A54445 View billing and coding requirements for the MolDX: MammaPrint LCD.
Billing and Coding: MolDX: MCOLN1 Genetic Testing A55283 There is insufficient evidence to support the required clinical utility for the established Medicare benefit category.
Billing and Coding: MolDX: MECP2 Genetic Testing A55285 View billing and coding requirements for MECP2 Genetic Testing.
Billing and Coding: MolDX: Melanoma Risk Stratification Molecular Testing A57268 View billing and coding requirements for Melanoma Risk Stratification testing.
Billing and Coding: MolDX: MGMT Promoter Methylation Analysis A57432 View billing and coding requirements for MolDX: MGMT Promoter Methylation Analysis LCD.
Billing and Coding: MolDX: Microsatellite Instability-High (MSI-H) and Mismatch Repair Deficient (dMMR) Biomarker Billing and Coding Guidelines for Patients with Unresectable or Metastatic Sold Tumors A56103 View billing and coding requirements for the MolDX: Genetic Testing for Lynch Syndrome LCD.
Billing and Coding: MolDX: Minimal Residual Disease Testing for Colorectal Cancer A58448 View billing and coding requirements for MolDX: Minimal Residual Disease Testing.
Billing and Coding: MolDX: Minimal Residual Disease Testing for Hematologic Cancers A58996 View coverage and billing requirement for Billing and Coding: MolDX: Minimal Residual Disease Testing for Hematologic Cancers
Billing and Coding: MolDX: Minimal Residual Disease Testing for Solid Tumor Cancers A58454 View coverage and billing requirement for Billing and Coding: MolDX: Minimal Residual Disease Testing for Solid Tumor Cancers
Billing and Coding: MolDX: Mitochondrial Nuclear Gene Tests A55290 View updated coverage and billing requirements for MolDX: Mitochondrial Nuclear Gene Tests.
Billing and Coding: MolDX: MMACHC Test Billing and Coding Guidelines A55288 View billing and coding guidelines for MolDX: MMACHC testing.
Billing and Coding: MolDX: Molecular Diagnostic Tests (MDT) A57526 View billing and coverage requirements for the MolDX: Molecular Diagnostic Tests (MDT) LCD.
Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing A58720 View coverage and billing requirement for Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
Billing and Coding: MolDX: Molecular Testing for Solid Organ Allograft Rejection A58168 View coverage and billing requirements for MolDX: Molecular Testing for Solid Organ Allograft Rejection
Billing and Coding: MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels A57338 View billing and coding requirements for MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels LCD.
Billing and Coding: MolDX: myPap Update A55292 View updated billing and coding requirements for MolDX: myPap Tests.
Billing and Coding: MolDX: myPath® Melanoma Assay A57626 View coverage and billing requirement for Billing and Coding: MolDX: myPath® Melanoma Assay
Billing and Coding: MolDX: Next-Generation Sequencing for Solid Tumors A57901 View billing and coding requirements for Next-Generation Sequencing Testing.
Billing and Coding: MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies A57891 View billing and coding requirements for Next-Generation Sequencing for Myeloid Malignancies and suspected malignancies.
Billing and Coding: MolDX: NRAS Genetic Testing A57486 View billing and coding requirements for the MolDX: NRAS Genetic Testing LCD.
Billing and Coding: MolDX: NSD1 Gene Tests A55609 View coverage and billing requirements for MolDX: NSD1 Gene Tests.
Billing and Coding: MolDX: Oncotype DX® Breast Cancer Assay A54480 View billing and coding requirements for the MolDX: OncotypeDX® Breast Cancer Assay LCD.
Billing and Coding: MolDX: Oncotype DX® Breast Cancer for (DCIS) Genomic Health™ A57619 View billing and coding requirements for the MolDX: Oncotype DX® Breast Cancer for (DCIS) Genomic Health™ LCD.
Billing and Coding: MolDX: Oncotype DX® Colon Cancer A54484 View billing and coding requirements for the MolDX: OncotypeDX® Colon Cancer Assay LCD.
Billing and Coding: MolDX: PAX6 Gene Sequencing A55625 View billing and coding guidelines for MolDX: PAX6 Gene Sequencing.
Billing and Coding: MolDX: Percepta© Bronchial Genomic Classifier A57502 View billing and coding requirements for the MolDX: Percepta© Bronchial Genomic Classifier LCD.
Billing and Coding: MolDX: Pharmacogenomics Testing A57384 View billing and coding requirements for Billing and Coding: MolDX: Pharmacogenomics Testing LCD.
Billing and Coding: MolDX: Phenotypic Biomarker Detection in Circulating Tumor Cells A58183 View coverage and billing requirements for  MolDX: Phenotypic Biomarker Detection in Circulating Tumor Cells
Billing and Coding: MolDX: Pigmented Lesion Assay A58052 View coverage and billing requirement for Billing and Coding: MolDX: Pigmented Lesion Assay
Billing and Coding: MolDX: PIK3CA Gene Tests A55597 View billing and coding requirements for MolDX: PIK3CA Gene Tests.
Billing and Coding: MolDX: Plasma-Based Genomic Profiling in Solid Tumors A58973 View coverage and billing requirements for MolDX: Plasma-Based Genomic Profiling in Solid Tumors
Billing and Coding: MolDX: Predictive Classifiers for Early Stage Non-Small Cell Lung Cancer A57329 View billing and coding requirements for the MolDX: Predictive Classifiers for Early Stage Non-Small Cell Lung Cancer LCD.
Billing and Coding: MolDX: PreDx® A55594 View billing and coding requirements for MolDX: PreDx®.
Billing and Coding: MolDX: Progensa® PCA3 Assay A54489 View billing and coding requirements for the MolDX: Progensa® PCA3 Assay LCD.
Billing and Coding: MolDX: Prognostic and Predictive Molecular Classifiers for Bladder Cancer A58181 View coverage and billing requirements for MolDX: Prognostic and Predictive Molecular Classifiers for Bladder Cancer
Billing and Coding: MolDX: Prometheus IBD sgi Diagnostic Policy A57516 View billing and coding requirements for the MolDX: Prometheus IBD sgi Diagnostic Policy LCD.
Billing and Coding: MolDX: Prostate Cancer Genomic Classifier Assay for Men with Localized Disease A57372 View billing and coding requirements for Prostate Cancer Genomic Classifier assay for men with localized disease.
Billing and Coding: MolDX: PTCH1 Gene Testing A55608 View billing and coding requirements for MolDX: PTCH1 Gene Testing.
Billing and Coding: MolDX: Repeat Germline Testing A57331 View billing and coding requirements for Repeat Germline Testing.
Billing and Coding: MolDx: ResponseDX Tissue of Origin® Billing and Coding Guidelines A54494 View billing and coding requirements for the MolDX: ResponseDX Tissue of Origin® LCD.
Billing and Coding: MolDX: RPS19 Gene Tests A55610 View coverage and billing requirements for MolDX: RPS19 Gene Tests.
Billing and Coding: MolDX: SETP9 Gene Test A55623 View billing and coding guidelines for MolDX: SETP9 Gene Tests.
Billing and Coding: MolDX: SMPD1 Genetic Testing A55627 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.
Billing and Coding: MolDX: STAT3 Gene Testing A55480 There is insufficient evidence to support the required clinical utility for the established Medicare benefit category.
Billing and Coding: MolDX: SULT4A1 Genetic Testing A55596 View billing and coding requirements for MolDX: SULT4A1 Genetic Testing.
Billing and Coding: MolDX: Targeted and Comprehensive Genomic Profile Next-Generation Sequencing Testing in Cancer A55624 View coverage and billing requirements for Targeted and Comprehensive Genomic Profile Next-Generation Sequencing Testing in Cancer.
Billing and Coding: MolDX: TERC Gene Tests A55611 View billing and coding requirements for MolDX: TERC Gene Tests.
Billing and Coding: MolDX: Testing of Multiple Genes A58120 View billing and coding requirements for MolDX: Testing of Multiple Genes.
Billing and Coding: MolDX: ThermoFisher Oncomine Dx Target Test for Non-Small Cell Lung Cancer A55881 View billing and coding requirements for the MolDX: ThermoFisher Oncomine DX Target Test for Non-Small Cell Lung Cancer LCD.
Billing and Coding: MolDX: TP53 Gene Test Billing and Coding Guidelines A55484 View coverage and billing requirements for the TP53 Gene Test.
Billing and Coding: MolDX: VEGFR2 Tests A55468 View billing and coding guidelines for MolDX: VEGFR2.
Billing and Coding: MRI and CT Scans of the Head and Neck A57204 View billing and coding requirements for MRI and CT Scans of the Head and Neck LCD.
Billing and Coding: Nerve Blockade for Treatment of Chronic Pain and Neuropathy A56034 View billing and coding requirements for Nerve Blockade for Treatment of Chronic Pain and Neuropathy LCD.
Billing and Coding: Nerve Conduction Studies and Electromyography A54969 View billing and coding requirements for the Nerve Conduction Studies and Electromyography LCD.
Billing and Coding: Non-Invasive Fractional Flow Reserve (FFR) for Stable Ischemic Heart Disease A58095 View billing and coding requirement for Non-Invasive Fractional Flow Reserve (FFR) for Stable Ischemic Heart Disease.
Billing and Coding: Outpatient Therapy Biofeedback Training A53352 View Medicare coverage and billing of Outpatient Therapy Biofeedback Training.
Billing and Coding: Patients Supplied Donated or Free-of-Charge Drug A55044 View coverage and billing requirements for Billing and Coding: Patients Supplied Donated or Free-of-Charge Drug.
Billing and Coding: Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF) A56572 View billing and coding requirements for Percutaneous Vertebral Augmentation LCD.
Billing and Coding: Peripheral Nerve Stimulation A55530 View billing and coding requirements for Peripheral Nerve Stimulation LCD.
Billing and Coding: Physician Supervision of Dialysis for Acute Kidney Injury A55992 View coverage and billing requirements for Physician Supervision of Dialysis for Acute Kidney Injury Coverage.
Billing and Coding: Piriformis Injections A56027 View coverage and billing requirements for Piriformis Injections Coverage.
Billing and Coding: Plastic Surgery A57221 View billing and coding requirements for Plastic Surgery Policy.
Billing and Coding: Platelet Rich Plasma Injections for Non-Wound Injections A58788 View billing and coding requirements for Platelet Rich Plasma Injections
Billing and Coding: Polysomnography and Other Sleep Studies A57697 View billing and coding requirements for Polysomnography and Other Sleep Studies LCD.
Billing and Coding: Posterior Tibial Nerve Stimulation Coverage A55104 View coverage and billing requirements for Posterior Tibial nerve Stimulation Coverage.
Billing and Coding: ProMark Risk Score A57515 View billing and coding requirements for ProMark Risk Score LCD.
Billing and Coding: Pulmonary Function Testing A57216 View billing and coding requirements for Pulmonary Function Testing LCD.
Billing and Coding: Pulmonary Rehabilitation Services A56152 View coverage, coding and billing information for Pulmonary Rehabilitation Services defined by the SSA, NCD and CMS manuals, including contractor determined coding criteria.
Billing and Coding: Remote Imaging of the Retina to Screen for Retinal Diseases A58384 View billing and coding guidelines for Remote Imaging of the Retina to screen for Retinal Diseases.
Billing and Coding: Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder A57692 View billing and coding requirements for (Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder) LCD.
Billing and Coding: Reporting a Non-Covered Test Performed in Preparation for a Non-Covered Procedure A55774 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.
Billing and Coding: Respiratory Care (Respiratory Therapy) A57224 View billing and coding requirements for Respiratory Care (Respiratory Therapy) LCD.
Billing and Coding: Routine Foot Care A57954 View coverage and billing requirements for Billing and Coding: Routine Foot Care Coverage.
Billing and Coding: Sacroiliac Joint Injections and Procedures A59244 View coverage and billing requirements for Sacroiliac Joint Injections and Procedures
Billing and Coding: Sclerosing of Varicose Veins A53084 View information regarding incorrect coding for CPT 37241 for varicose vein ablation.
Billing and Coding: Serum Magnesium A57189 View billing and coding requirements for Serum Magnesium LCD.
Billing and Coding: Short Tandem Repeat (STR) Markers and Chimerism (CPT® codes 81265-81268) A57842 View coverage and billing requirement for Billing and Coding: Short Tandem Repeat (STR) Markers and Chimerism (CPT® codes 81265-81268)
Billing and Coding: Single Chamber and Dual Chamber Permanent Cardiac Pacemakers - Coding and Billing A54929 View Coverage and Billing requirements for Single Chamber and Dual Chamber Permanent Cardiac Pacemakers
Billing and Coding: Spinal Cord Stimulators for Chronic Pain A57791 View billing and coding requirements for Spinal Cord Stimulators for Chronic Pain LCD.
Billing and Coding: Spinal Fusion Services: Documentation Requirements A53972 View clarification of medical necessity and documentation requirements.
Billing and Coding: Spinraza® (Nusinersen) A58578 View coverage and billing requirements for Billing and Coding for Spinraza® (Nusinersen).
Billing and Coding: Testopel Coverage A55056 View coverage guidelines for Testopel pellets.
Billing and Coding: Therapy Driving Evaluations A53292 View Medicare coverage and billing guide for Therapy Driving Evaluations.
Billing and Coding: Therapy Evaluation Coding A55371 View coverage and billing requirements for Therapy Evaluation Coding Coverage.
Billing and Coding: Therapy Evaluation, Re-Evaluation and Formal Testing A53309 View coverage and billing requirements for Therapy Evaluation and Formal Testing Coverage.
Billing and Coding: Therapy Students and Aides A53339 View coverage and billing requirements for Therapy Students and Aides Coverage.
Billing and Coding: Tomosynthesis-Guided Breast Biopsy A57848 View billing and coding requirements for Tomosynthesis-Guided Breast Biopsy.
Billing and Coding: Topical HBO and Physician Related Service Billing and Coding Guidelines A56025 View coverage and billing requirements for Topical HBO and Physician Related Service Billing and Coding Guidelines.
Billing and Coding: Total Hip Arthroplasty A57683 View billing and coding requirements for Total Hip Arthroplasty LCD.
Billing and Coding: Total Knee Arthroplasty A57685 View billing and coding requirements for Total Knee Arthroplasty LCD.
Billing and Coding: Transurethral Waterjet Ablation of the Prostate A58227 View billing and coding requirements for Transurethral Waterjet Ablation of the Prostate.
Billing and Coding: Treatment of Males with Low Testosterone A57615 View billing and coding requirements for Treatment of Males with Low Testosterone LCD.
Billing and Coding: Treatment of Varicose Veins of the Lower Extremities A57706 View billing and coding requirements for Treatment of Varicose Veins of the Lower Extremities LCD.
Billing and Coding: Treatment with Yttrium-90 Microspheres A54072 View coverage and billing requirements for Yttrium-90 Microspheres.
Billing and Coding: Trigger Point Injections A57701 View billing and coding requirements for Trigger Point Injections LCD.
Billing and Coding: Vitamin D Assay Testing A57718 View billing and coding requirements for Vitamin D Assay Testing LCD.
Billing and Coding: Wound and Ulcer Care A58565 View coverage and billing requirements for Billing and Coding: Wound and Ulcer Care
Billing and Coding: Wound Care & Debridement-Provided by a Therapist, Physician, NPP or as Incident-to Services A53296 View coverage and billing requirements for Wound Care & Debridement – Provided by a Therapist, Physician, NPP or as Incident-to Services Coverage.
Billing and Coding: Zika Virus Testing by PCR and ELISA Methods A55326 View Zika Virus billing and coverage information.
Dropless Cataract Surgery A53916 View Coverage and Billing requirements for Dropless Cataract Surgery
Investigational Device Exemptions(IDE) - IDE Documentation Requirements for Studies with an FDA Approval dated January 01, 2015 or Later A54919 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.
MolDX: Algorithm definition as a component of a laboratory test A58673 View coverage requirements for MolDX: Algorithm definition as a component of a laboratory test
Non-Payment for Prefabricated Splints A56112 View coverage and billing guidelines for non-payment of prefabricated splints.
Noncoverage of Peripheral Nerve Field Stimulation - Coding and Billing A55530 View coverage and billing requirements for Noncoverage of Peripheral Nerve Field Stimulation – Coding and Billing.
Parenteral Iron Administration Coverage in Non-Dialysis Usage A55653 View coverage description for the Parenteral Iron Administration Coverage in Non-Dialysis Usage.
Pegfilgrastim (Neulasta) J2505 A52889 View coverage and medical necessity guidelines for Pegfilgrastim (Neulasta) J2505 Coverage.
Post Market Studies and Post Market Extension Studies - Percutaneous Transluminal Angioplasty (PTA) with Carotid Stenting and Embolic Protection N/A View coverage and reimbursement for specific "post-marketing studies" may be approved by Medicare contractors. These studies all involve the use of percutaneous transluminal angioplasty (PTA) with carotid stenting and embolic protection.
Sipuleucel-T (Provenge®) - Coverage Criteria for Prostate Cancer - Clarification A55719 View clarification for coverage criteria for Prostate Cancer.
Sterilization A53356 View billing and coding requirements for Sterilization.
Therapeutic Apheresis for Familial Hypercholesterolemia A54543 View coverage information for therapeutic apheresis in the treatment of refractory familial hypercholesterolemia.
Waiver of Face-to-Face Visit for Home Dialysis Patients - Coding and Billing A55058 View coding guidelines to request waiver with 52 modifier to the appropriate monthly capitation CPT codes 90963-90966.

 

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Last Updated Thu, 02 Mar 2023 14:54:19 +0000