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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.

NEW! As articles are updated in the MCD, we will publish them as webpages on our website as well. Watch the below list continue to expand as updates are made.

NOTE: Coverage topics are not created for every situation or provider type; however, if one has been published and it is applicable to a specific "Browse by Topic" or "Browse by Provider Type," be sure to look there.

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Topic Brief Description
Chemotherapy Administration View coverage and billing requirements for Chemotherapy Administration Coverage.
DecisionDX-UM Billing Guidelines View billing guidelines for DecsionDx-UM™
Cosmetic vs. Reconstructive Surgery Coverage View clarification of Medicare coverage and defines cosmetic versus reconstructive surgical procedures.
Dropless Cataract Surgery View coverage and billing information for Dropless Cataract Surgery. 
E/M Services and Drug Administration Billing 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.
HemoDialysis Frequency  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.
Hydration Services View use and medical necessity requirements of hydration services. 
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  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.
NMP22 Bladder Check Test for Monitoring Bladder Cancer  View coverage information for the NMP22 Bladder Check Test for Monitoring Bladder Cancer. ..
Outpatient Therapy Biofeedback Training View Medicare coverage and billing of Outpatient Therapy Biofeedback Training. 
Parenteral Iron Administration in Beneficiaries with Chronic Kidney Disease (CKD) with Iron Deficiency Anemia (IDA) or Reduced Iron Stores This article is intended to address the use of parenteral iron preparations in patients with a diagnosis of Chronic Kidney Disease (CKD). 
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
Routine Dental Services 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.
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. 
Urolift Coverage View coverage service for Physician and Facility billing information for Urolift. 
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 View Zika Virus billing and coverage information

 

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Last Updated Mar 17, 2017