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 A56515 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: B-type Natriuretic Peptide (BNP) Testing A57084 View billing and coding requirements for B-type Natriuretic Peptide (BNP) Testing Policy.
Billing and Coding: Benign Skin Lesion Removal (Excludes Actinic Keratosis and MOHS) A57162 View billing and coding requirements for the Benign Skin Lesion Removal (Excludes Actinic Keratosis and MOHS LCD.
Billing and Coding: Billing Medicare for the SphenoCath and Other Similar Devices A55585 View coverage and billing requirements for Billing Medicare for the SphenoCath® Device Coverage.
Billing and Coding: Blepharoplasty, Eyelid Surgery, and Brow Lift A57191 View billing and coding requirements for Blepharoplasty, Eyelid Surgery, and Brow Lift Policy
Billing and Coding: Botulinum Toxin Types A and B Policy A57186 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 A57184 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 A57196 View billing and coding requirements for Cataract Surgery in Adults Policy
Billing and Coding: Chest X-Ray A57498 View billing and coding requirements for Chest X-Ray Policy
Billing and Coding: Complex Drug Administration Coding A58533 View coverage and billing requirements for Billing and Coding: Complex Drug Administration Coding Coverage.
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 A54662 View coverage and billing requirements for IVIG for Treatment of Primary Immune Deficiency Diseases in the Home.
Billing and Coding: Diagnostic and Therapeutic Colonoscopy A57343 View billing and coding requirements for Diagnostic and Therapeutic Colonoscopies
Billing and Coding: Electrocardiograms A57327 View billing and coding requirements for Electrocardiogram LCD.
Billing and Coding: Facet Joint Interventions for Pain Management A58405 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) A56711 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 A52767 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 A55676 View coding and billing requirements for Hemodialysis Sessions.
Billing and Coding: Guardant360® A58214 View billing and coding requirements for Guardant360®
Billing and Coding: High Compression Bandage System Clarification A52768 View coverage and billing requirements for High Compression Bandage System Clarification Coverage.
Billing and Coding: HLA-DQB1*06:02 Testing for Narcolepsy A57465 View billing and coding requirements for the HLA-DQB1*06:02 Testing for Narcolepsy LCD.
Billing and Coding: Home PT/INR Monitoring Billing and Coding A55756 View coding and billing guidance related to the NCD for Home Prothrombin Time/International Normalized Ration Monitoring for Anticoagulation Monitoring.
Billing and Coding: Hydration Services A52732 View coverage and billing requirements for Hydration Services Coverage.
Billing and Coding: Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea A57949 View Billing and Coding Guidelines for Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea
Billing and Coding: Immune Globulin Intravenous (IVIg) A57194 View billing and coding requirements for the Immune Globulin Intravenous (IVIg) LCD.
Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM) A58138 View billing and coding guidelines for Implantable Continuous Glucose Monitors
Billing and Coding: Implantable Infusion Pumps for Chronic Pain A55323 View information regarding implanted Infusion Pumps for Chronic pain and Compounded Drugs
Billing and Coding: In Vitro Chemosensitivity & Chemoresistance Assays A56073 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 A55214 View key points related to "incident to" regulations in an outpatient hospital setting
Billing and Coding: Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma A57201 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) A58245 View billing and coding requirements for Intensity Modulated Radiation Therapy (IMRT) services.
Billing and Coding: Intraocular Bevacizumab A53009 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 A55062 View appropriate ICD-10 CM diagnoses for endometrial hyperplasia and use of CPT 58999.
Billing and Coding: JW Modifier Billing Guidelines A55932 View coverage and billing requirements for Billing and Coding: JW Modifier Billing Guidelines article
Billing and Coding: Lab: Bladder/Urothelial Tumor Markers A55029 View billing and coding requirements for Lab: Bladder/Urothelial Tumor Markers LCD.
Billing and Coding: Lab: Coenzyme Q10 (CoQ10) A55770 View billing and coding requirements for Lab: Coenzyme Q10 (CoQ10) LCD.
Billing and Coding: Lab: Controlled Substance Monitoring and Drugs of Abuse Testing A55030 View billing and coding requirements for Lab: Controlled Substance Monitoring and Drugs of Abuse Testing Policy
Billing and Coding: Lab: Flow Cytometry A57690 View billing and coding requirements for Flow Cytometry LCD.
Billing and Coding: Lab: Special Histochemical Stains and Immunohistochemical Stains A57614 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 A55803 View billing and coding requirements for IHC Indications for Gastric Pathology.
Billing and Coding: Lumbar Epidural Injections A57203 View billing and coding requirements for Lumbar Epidural Injections LCD.
Billing and Coding: Lumbar MRI A57207 View billing and coding requirements for Lumbar MRI LCD.
Billing and Coding: Lymphedema Decongestive Treatment A52959 View coverage and billing requirements for Lymphedema Decongestive Treatment Coverage.
Billing and Coding: Measurement of Salivary Hormones A57613 View billing and coding requirements for the Measurement of Salivary Hormones LCD.
Billing and Coding: Medical Necessity of Therapy Services A52775 View coverage and billing requirements for Medical Necessity of Therapy Services Coverage.
Billing and Coding: Micro-Invasive Glaucoma Surgery (MIGS) A57864 View billing and coding requirements for Micro-Invasive Glaucoma Surgery (MIGS) LCD.
Billing and Coding: Mohs Micrographic Surgery A56515 View billing and coding requirements for Mohs Micrographic Surgery LCD.
Billing and Coding: MolDX: 4K Score Assay A57337 View billing and coding requirements for the MolDX: 4K Score Assay LCD.
Billing and Coding: MolDX: 4q25-AF Risk Genotype A55091 View billing and coding requirements for 4q25-AF Risk Genotype testing.
Billing and Coding: MolDX: 9p21 Genotype Test A55093 View billing and coding requirements for 9p21 Genotype testing.
Billing and Coding: MolDX: Abbott RealTime IDH2 testing for Acute Myeloid Leukemia (AML) A55712 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 A54358 View billing and coding requirements for the Afirma Assay by Veracyte.
Billing and Coding: MolDX: AlloMap A54366 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 A57233 View billing and coding requirements for Allosure® or Equivalent cell-free DNA.
Billing and Coding: MolDX: APC and MUTYH Gene Testing A57353 View billing and coding requirements for the MolDX: APC and MUTYH Gene Testing LCD.
Billing and Coding: MolDX: ApoE Genotype Billing and Coding Guidelines A55095 View coverage and billing guidelines for ApoE Genotype testing.
Billing and Coding: MolDX: Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C) Testing A54976 View billing and coding requirements for Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C) Testing
Billing and Coding: MolDX: Aspartoacyclase 2 Deficiency (ASPA) Testing A55089 View billing and coding requirements for Aspartoacyclase 2 Deficiency (ASPA) Testing
Billing and Coding: MolDX: ATP7B Gene Tests A55098 View billing and coding requirements for ATP7B gene testing.
Billing and Coding: MolDX: Avise PG Assay A54378 View billing and coding requirements for the MolDX:Avise PG Assay LCD.
Billing and Coding: MolDX: BCKDHB Gene Test A55100 View billing and coding requirements for BCKDHB Gene Testing.
Billing and Coding: MolDX: BCR-ABL A55600 View billing and coding requirements for MolDX: BCR-ABL.
Billing and Coding: MolDX: BDX-XL2 A57357 View billing and coding requirements for the MolDX: BDX-XL2 LCD
Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment A57055 View billing and coding requirements for the LCD
Billing and Coding: MolDX: bioTheranostics Cancer TYPE ID® A54388 View billing and coding requirements for the MolDX:bioTheranostics Cancer Type ID® LCD.
Billing and Coding: MolDX: BLM Gene Analysis A55114 View billing and coding requirements for BLM Gene Analysis.
Billing and Coding: MolDX: Blood Product Molecular Antigen Typing A57376 View billing and coding requirements for Blood Product Antigen typing.
Billing and Coding: MolDX: BluePrint® A55116 View billing and coding requirements for BluePrint®.
Billing and Coding: MolDX: BRCA1 and BRCA2 Genetic Testing A57355 View billing and coding requirements for the MolDX: BRCA1 and BRCA2 Genetic Testing LCD.
Billing and Coding: MolDX: Breast Cancer Assay: Prosigna A57364 View billing and coding requirements for the MolDX: Breast Cancer Assay: Prosigna LCD.
Billing and Coding: MolDX: Breast Cancer IndexTM (BCI) Gene Expression Test A57774 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 A55971 View billing and coding requirements for MolDX CDH1 Genetic Testing
Billing and Coding: MolDX: CHD7 Gene Analysis Coding and Billing Guidelines A55086 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: Clonoseq® Assay for Assessment of Minimal Residual Disease (MRD) in Patients with Specific Lymphoid Malignancies A56323 View coverage and billing requirements for MolDX: Clonoseq® Assay for Assessment of Minimal Residual Disease (MRD) in Patients with Specific Lymphoid Malignancies coverage.
Billing and Coding: MolDX: ConfirmMDx Epigenetic Molecular Assay A57606 View billing and coding requirements for the MolDX: ConfirmMDx Epigenetic Molecular Assay LCD.
Billing and Coding: MolDX: Corus CAD® Assay A57416 View billing and coding requirements for the MolDX: Corus CAD® Assay LCD.
Billing and Coding: MolDX: Cystatin C Measurement A57644 View billing and coding requirements for MolDX: Cystatin C Measurement LCD.
Billing and Coding: MolDX: DecisionDX-Melanoma A57418 View billing and coding requirements for the MolDX: DecisionDX-Melanoma LCD.
Billing and Coding: MolDX: DecisionDX-UM (Uveal Melanoma) A57622 View billing and coding requirements for the MolDX: DecisionDX-UM (Uveal Melanoma) LCD.
Billing and Coding: MolDX: EndoPredict® Breast Cancer Gene Expression Test A57608 View billing and coding requirements for the MolDX: EndoPredict® Breast Cancer Gene Expression Test LCD.
Billing and Coding: MolDX: ENG and ACVRL1 Gene Tests A55182 View billing and coding requirements for ENG and ACVRL1 Gene Tests.
Billing and Coding: MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test A57420 View billing and coding requirements for the MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test LCD.
Billing and Coding: MolDX: FANCC Genetic Testing A55184 View billing and coding guidelines for FANCC Genetic testing.
Billing and Coding: MolDX: FDA Approved CLL Companion Diagnostic Test A56013 View coverage and billing requirements for MolDX: FDA Approved CLL Companion Diagnostic Testing
Billing and Coding: MolDX: FDA-Approved BRAF Tests A54420 View billing and coding requirements for FDA-Approved BRAF testing.
Billing and Coding: MolDX: FDA-Approved EGFR Tests A54424 View billing and coding requirements for the MolDX: FDA-Approved EGFR Tests LCD.
Billing and Coding: MolDX: FDA-Approved KRAS Tests A54500 View billing and coding requirements for the MolDX: FDA-Approved KRAS LCD.
Billing and Coding: MolDX: Fragile X Update A55242 View billing and coding requirements for Fragile X.
Billing and Coding: MolDX: GBA Genetic Testing A55244 View billing and coding requirements for Abbreviated Daytime Sleep Studies
Billing and Coding: MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease A57422 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) A57424 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 A54996 View coverage and billing requirements for Lynch Syndrome Testing.
Billing and Coding: MolDX: HAX1 Gene Sequencing A55252 View billing and coding requirements for HAX1 Gene Sequencing.
Billing and Coding: MolDX: HBB Gene Tests A55254 View billing and coding requirements for MolDX: HBB Gene Tests.
Billing and Coding: MolDX: HERmark Assay by Monogram A54439 View billing and coding requirements for the MolDX: HERmark Assay by Monogram LCD.
Billing and Coding: MolDX: HEXA Gene Analysis A55256 View billing and coding requirements for HEXA Gene Analysis
Billing and Coding: MolDX: HTTLPR Gene Testing A55265 View billing and coding requirements for HTTLPR gene testing.
Billing and Coding: MolDX: IKBKAP Genetic Testing A55613 View billing and coding requirements for MolDX: IKBKAP Genetic Testing.
Billing and Coding: MolDX: Immunohistochemistry (IHC) Indication for Breast Pathology A57797 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 A57665 View billing and coding requirements for MolDX: Inivata, InVisionFirst, Liquid Biopsy for Patients with Lung Cancer LCD.
Billing and Coding: MolDX: KIF6 Genotype A55273 View billing and coding requirements for KIF6 genotype testing.
Billing and Coding: MolDX: Know Error Update A55275 View updated billing and coding requirements for MolDX: Know error.
Billing and Coding: MolDX: L1CAM Gene Sequencing A55278 View coverage and billing requirements for MolDX: L1CAM Gene Sequencing.
Billing and Coding: MolDX: LPA-Aspirin Genotype A55280 View billing and coding requirements for MolDX: LPA-Asprin Genotype testing.
Billing and Coding: MolDX: LPA-Intron 25 Genotype A55282 View billing and coding requirements for MolDX: LPA-Intron 25 Genotype testing.
Billing and Coding: MolDX: MammaPrint A54447 View billing and coding requirements for the MolDX: MammaPrint LCD.
Billing and Coding: MolDX: MCOLN1 Genetic Testing A55284 There is insufficient evidence to support the required clinical utility for the established Medicare benefit category.
Billing and Coding: MolDX: MDS FISH A57662 View billing and coding requirements for MolDX: MDS FISH LCD.
Billing and Coding: MolDX: MECP2 Genetic Testing A55286 View billing and coding requirements for MECP2 Genetic Testing.
Billing and Coding: MolDX: Melanoma Risk Stratification Molecular Testing A57290 View billing and coding requirements for Melanoma Risk Stratification testing.
Billing and Coding: MolDX: MGMT Promoter Methylation Analysis A57433 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 A56104 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 A58449 View billing and coding requirements for MolDX: Minimal Residual Disease Testing.
Billing and Coding: MolDX: Mitochondrial Nuclear Gene Tests A55291 View updated coverage and billing requirements for MolDX: Mitochondrial Nuclear Gene Tests.
Billing and Coding: MolDX: MMACHC Test Billing and Coding Guidelines A55289 View billing and coding guidelines for MolDX: MMACHC testing
Billing and Coding: MolDX: Molecular Diagnostic Tests (MDT) A57527 View billing and coverage requirements for the MolDX: Molecular Diagnostic Tests (MDT) LCD.
Billing and Coding: MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels A57340 View billing and coding requirements for MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels LCD.
Billing and Coding: MolDX: myPap Update A55293 View updated billing and coding requirements for MolDX: myPap Tests.
Billing and Coding: MolDX: Myriad's BRACAnalysis CDx™ A55294 View billing and coding requirements for the MolDX: Myriad's BRACAnalysis CDx™ LCA.
Billing and Coding: MolDX: Next-Generation Sequencing for Solid Tumors A57905 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 A57892 View billing and coding requirements for Next-Generation Sequencing for Myeloid Malignancies and suspected malignancies.
Billing and Coding: MolDX: NRAS Genetic Testing A57487 View billing and coding requirements for the MolDX: NRAS Genetic Testing LCD.
Billing and Coding: MolDX: NSD1 Gene Tests A55615 View coverage and billing requirements for MolDX: NSD1 Gene Tests.
Billing and Coding: MolDX: Oncotype DX® Breast Cancer Assay A54482 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™ A57620 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 A54486 View billing and coding requirements for the MolDX: OncotypeDX® Colon Cancer Assay LCD.
Billing and Coding: MolDX: PAX6 Gene Sequencing A55632 View billing and coding guidelines for MolDX: PAX6 Gene Sequencing
Billing and Coding: MolDX: Percepta© Bronchial Genomic Classifier A57504 View billing and coding requirements for the MolDX: Percepta© Bronchial Genomic Classifier LCD.
Billing and Coding: MolDX: Pharmacogenomics Testing A57385 View Billing and Coding requirements for Billing and Coding: MolDX: Pharmacogenomics Testing LCD.
Billing and Coding: MolDX: PIK3CA Gene Tests A55602 View billing and coding requirements for MolDX: PIK3CA Gene Tests.
Billing and Coding: MolDX: Predictive Classifiers for Early Stage Non-Small Cell Lung Cancer A57330 View Billing and Coding requirements for the MolDX: Predictive Classifiers for Early Stage Non-Small Cell Lung Cancer LCD.
Billing and Coding: MolDX: PreDx® A55599 View billing and coding requirements for MolDX: PreDx®.
Billing and Coding: MolDX: Progensa® PCA3 Assay A54492 View billing and coding requirements for the MolDX: Progensa® PCA3 Assay LCD.
Billing and Coding: MolDX: Prolaris Cancer Genomic Assay A57511 View billing and coding requirements for the MolDX: Prolaris™ Cancer Genomic Assay LCD.
Billing and Coding: MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate risk Disease A57691 View billing and coding requirements for the Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate risk Disease LCD.
Billing and Coding: MolDX: ProMark Risk Score A57609 View billing and coding requirements for MolDX: ProMark Risk Score LCD.
Billing and Coding: MolDX: Prometheus IBD sgi Diagnostic Policy A57517 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 A57236 View billing and coding requirements for Prostate Cancer Genomic Classifier assay for men with localized disease
Billing and Coding: MolDX: PTCH1 Gene Testing A55618 View billing and coding requirements for MolDX: PTCH1 Gene Testing.
Billing and Coding: MolDX: Repeat Germline Testing A57332 View billing and coding requirements for Repeat Germline Testing
Billing and Coding: MolDx: ResponseDX Tissue of Origin® A54496 View billing and coding requirements for the MolDX: ResponseDX Tissue of Origin® LCD.
Billing and Coding: MolDX: RPS19 Gene Tests A55614 View coverage and billing requirements for MolDX: RPS19 Gene Tests.
Billing and Coding: MolDX: SETP9 Gene Test Billing and Coding Guidelines A55628 View billing and coding guidelines for MolDX: SETP9 Gene Tests
Billing and Coding: MolDX: SMPD1 Genetic Testing A55631 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 A55481 There is insufficient evidence to support the required clinical utility for the established Medicare benefit category.
Billing and Coding: MolDX: SULT4A1 Genetic Testing A55601 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 A56518 View coverage and billing requirements for Targeted and Comprehensive Genomic Profile Next-Generation Sequencing Testing in Cancer.
Billing and Coding: MolDX: TERC Gene Tests A55616 View billing and coding requirements for MolDX: TERC Gene Tests.
Billing and Coding: MolDX Testing of Multiple Genes A58121 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 A55888 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 A55487 View coverage and billing requirements for the TP53 Gene Test
Billing and Coding: MolDX: VEGFR2 Tests A55469 View billing and coding guidelines for MolDX: VEGFR2
Billing and Coding: MRI and CT Scans of the Head and Neck A57215 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 A52725 View billing and coding requirements for Nerve Blockade for Treatment of Chronic Pain and Neuropathy LCD.
Billing and Coding: Nerve Conduction Studies and Electromyography A54992 View billing and coding requirements for the Nerve Conduction Studies and Electromyography LCD.
Billing and Coding: Outpatient Therapy Biofeedback Training A52755 View Medicare coverage and billing of Outpatient Therapy Biofeedback Training.
Billing and Coding: Patients Supplied Donated or Free-of-Charge Drug A55045 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) A56573 View billing and coding requirements for Percutaneous Vertebral Augmentation LCD.
Billing and Coding: Peripheral Nerve Stimulation A55531 View billing and coding requirements for Peripheral Nerve Stimulation LCD.
Billing and Coding: Piriformis Injections A56028 View coverage and billing requirements for Piriformis Injections Coverage.
Billing and Coding: Plastic Surgery A57222 View billing and coding requirements for Plastic Surgery Policy.
Billing and Coding: Platelet Rich Plasma A58351 View coverage and billing requirements for Billing and Coding: Platelet Rich Plasma Coverage.
Billing and Coding: Polysomnography and Other Sleep Studies A57698 View billing and coding requirements for Polysomnography and Other Sleep Studies LCD.
Billing and Coding: Posterior Tibial Nerve Stimulation Coverage A52965 View coverage and billing requirements for Posterior Tibial nerve Stimulation Coverage.
Billing and Coding: Pulmonary Rehabilitation Services A52770 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 A58914 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 A57693 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 A55775 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) A57225 View billing and coding requirements for Respiratory Care (Respiratory Therapy) LCD.
Billing and Coding: Routine Dental Services A52977 ICD-10-CM codes that are considered routine dental services and are non covered.
Billing and Coding: Routine Foot Care A57957 View coverage and billing requirements for Billing and Coding: Routine Foot Care Coverage.
Billing and Coding: Sclerosing of Varicose Veins A53079 View information regarding incorrect coding for CPT 37241 for varicose vein ablation.
Billing and Coding: Serum Magnesium A57198 View billing and coding requirements for Serum Magnesium LCD.
Billing and Coding: Spinal Cord Stimulators for Chronic Pain A57792 View billing and coding requirements for Spinal Cord Stimulators for Chronic Pain LCD.
Billing and Coding: Spinal Fusion Services: Documentation Requirements A53975 View clarification of medical necessity and documentation requirements.
Billing and Coding: Testopel Coverage A55057 View coverage guidelines for Testopel pellets.
Billing and Coding: Therapy Driving Evaluations A52772 View Medicare coverage and billing guide for Therapy Driving Evaluations.
Billing and Coding: Therapy Evaluation Coding A55367 View coverage and billing requirements for Therapy Evaluation Coding Coverage.
Billing and Coding: Therapy Evaluation, Re-Evaluation and Formal Testing A52773 View coverage and billing requirements for Therapy Evaluation and Formal Testing Coverage.
Billing and Coding: Therapy Students and Aides A52776 View coverage and billing requirements for Therapy Students and Aides Coverage.
Billing and Coding: Tomosynthesis-Guided Breast Biopsy A57849 View billing ansd coding requirements for Tomosynthesis-Guided Breast Biopsy.
Billing and Coding: Topical HBO and Physician Related Service Billing and Coding Guidelines A56026 View coverage and billing requirements for Topical HBO and Physician Related Service Billing and Coding Guidelines
Billing and Coding: Total Hip Arthroplasty A57684 View billing and coding requirements for Total Hip Arthroplasty LCD.
Billing and Coding: Total Knee Arthroplasty A57686 View billing and coding requirements for Total Knee Arthroplasty LCD.
Billing and Coding: Treatment of Males with Low Testosterone A57616 View Billing and Coding requirements for Treatment of Males with Low Testosterone LCD.
Billing and Coding: Treatment of Ulcers and Symptomatic Hyperkeratoses A57460 View billing and coding requirements for Treatment of Ulcers and Symptomatic Hyperkeratoses LCD.
Billing and Coding: Treatment of Varicose Veins of the Lower Extremities A57707 View billing and coding requirements for Treatment of Varicose Veins of the Lower Extremities LCD.
Billing and Coding: Treatment with Yttrium-90 Microspheres A52950 View coverage and billing requirements for Yttrium-90 Microspheres.
Billing and Coding: Trigger Point Injections A57702 View Billing and Coding requirements for Trigger Point Injections LCD.
Billing and Coding: Vitamin D Assay Testing A57719 View billing and coding requirements for Vitamin D Assay Testing LCD.
Billing and Coding: Wound Care & Debridement-Provided by a Therapist, Physician, NPP or as Incident-to Services A53046 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 A55327 View Zika Virus billing and coverage information
Cosmetic vs. Reconstructive Surgery Coverage NA View clarification of Medicare coverage and defines cosmetic versus reconstructive surgical procedures.
Dropless Cataract Surgery A53918 View coverage and billing information for Dropless Cataract Surgery.
E/M Services and Drug Administration Billing NA View clarification of proper billing of evaluation and management (E/M) CPT codes with modifier 25 on same date as procedures and/or drug administration codes.
Investigational Device Exemptions (IDE) - IDE Documentation Requirements for Studies with an FDA Approval dated January 01, 2015 or Later A54917 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.
Non-Payment for Prefabricated Splints A52754 View coverage and billing guidelines for non-payment of prefabricated splints.
Noncoverage of Peripheral Nerve Field Stimulation - Coding and Billing A55531 View coverage and billing requirements for Noncoverage of Peripheral Nerve Field Stimulation – Coding and Billing.
Parenteral Iron Administration Coverage in Non-Dialysis Usage A55734 View coverage description for the Parenteral Iron Administration Coverage in Non-Dialysis Usage.
Pegfilgrastim (Neulasta) J2505 A55447 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 NA 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.
Sipuleucel-T (Provenge®) - Coverage Criteria for Prostate Cancer - Clarification A52926 View clarification for coverage criteria for Prostate Cancer
Therapeutic Apheresis for Familial Hypercholesterolemia A54545 View coverage information for therapeutic apheresis in the treatment of refractory familial hypercholesterolemia.
Use of Amniotic Membrane Derived Skin Substitutes A56156 Clinical use of amniotic membrane derived skin substitutes outside of the care of DFU and VSU as not reasonable and necessary and non-covered.
Waiver of Face-to-Face Visit for Home Dialysis Patients - Coding and Billing A55059 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, 07 Oct 2021 18:43:33 +0000