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 Brief Description
Billing and Coding for Pathology Services on the Same Date of Service (DOS) as Mohs Surgery [PDF] 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) [PDF] View coverage and billing requirements for Abbreviated Daytime Sleep Studies
Billing and Coding: B-type Natriuretic Peptide (BNP) Testing [PDF] 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) [PDF] 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 [PDF] View coverage and billing requirements for Billing Medicare for the SphenoCath® Device Coverage.
Billing and Coding: Blepharoplasty, Eyelid Surgery, and Brow Lift [PDF] View billing and coding requirements for Blepharoplasty, Eyelid Surgery, and Brow Lift Policy
Billing and Coding: Botulinum Toxin Types A and B Policy [PDF] 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 [PDF] 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 [PDF] View billing and coding requirements for Cataract Surgery in Adults Policy
Billing and Coding: Chemotherapy Administration [PDF] View coverage and billing requirements for Billing and Coding: Chemotherapy Administration Coverage.
Billing and Coding: Chest X-Ray [PDF] View billing and coding requirements for Chest X-Ray Policy
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 [PDF] View coverage and billing requirements for IVIG for Treatment of Primary Immune Deficiency Diseases in the Home.
Billing and Coding: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Intermediate Risk Disease [PDF] View Billing and Coding requirements for Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Intermediate Risk Disease LCD.
Billing and Coding: Diagnostic and Therapeutic Colonoscopy [PDF] View billing and coding requirements for Diagnostic and Therapeutic Colonoscopies
Billing and Coding: Electrocardiograms [PDF] View billing and coding requirements for Electrocardiogram LCD.
Billing and Coding: Facet Joint Injections, Medial Branch Blocks and Facet Joint Radiofrequency Neurotomy [PDF] View billing and Coding requirements for Facet Joint Injections, Medial Branch Blocks and Facet Joint Radiofrequency Neurotomy
Billing and Coding: Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification Tests (NAATs) [PDF] 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 [PDF] 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 [PDF] View coding and billing requirements for Hemodialysis Sessions.
Billing and Coding: Guardant360® [PDF] View billing and coding requirements for Guardant360®
Billing and Coding: Helicobacter Pylori Infection Testing [PDF] View billing and coding requirements for Heliocobacter Pylori Infection Testing LCD.
Billing and Coding: High Compression Bandage System Clarification [PDF] View coverage and billing requirements for High Compression Bandage System Clarification Coverage.
Billing and Coding: HLA-DQB1*06:02 Testing for Narcolepsy [PDF] 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 [PDF] 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 [PDF] View coverage and billing requirements for Hydration Services Coverage.
Billing and Coding: Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea [PDF] View Billing and Coding Guidelines for Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea
Billing and Coding: Immune Globulin Intravenous (IVIg) [PDF] View billing and coding requirements for the Immune Globulin Intravenous (IVIg) LCD.
Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM) [PDF] View billing and coding guidelines for Implantable Continuous Glucose Monitors
Billing and Coding: Implantable Infusion Pumps for Chronic Pain [PDF] View information regarding implanted Infusion Pumps for Chronic pain and Compounded Drugs
Billing and Coding: In Vitro Chemosensitivity & Chemoresistance Assays [PDF] 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 [PDF] 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 [PDF] 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) [PDF] View billing and coding requirements for Intensity Modulated Radiation Therapy (IMRT) services.
Billing and Coding: Intraocular Bevacizumab [PDF] 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 [PDF] View appropriate ICD-10 CM diagnoses for endometrial hyperplasia and use of CPT 58999.
Billing and Coding: JW Modifier Billing Guidelines [PDF] View coverage and billing requirements for Billing and Coding: JW Modifier Billing Guidelines article
Billing and Coding: Lab: Bladder/Urothelial Tumor Markers [PDF] View billing and coding requirements for Lab: Bladder/Urothelial Tumor Markers LCD.
Billing and Coding: Lab: Coenzyme Q10 (CoQ10) [PDF] View billing and coding requirements for Lab: Coenzyme Q10 (CoQ10) LCD.
Billing and Coding: Lab: Controlled Substance Monitoring and Drugs of Abuse Testing [PDF] View billing and coding requirements for Lab: Controlled Substance Monitoring and Drugs of Abuse Testing Policy
Billing and Coding: Lab: Flow Cytometry [PDF] View billing and coding requirements for Flow Cytometry LCD.
Billing and Coding: Lab: Special Histochemical Stains and Immunohistochemical Stains [PDF] 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 [PDF] View billing and coding requirements for IHC Indications for Gastric Pathology.
Billing and Coding: Lumbar Epidural Injections [PDF] View billing and coding requirements for Lumbar Epidural Injections LCD.
Billing and Coding: Lumbar MRI [PDF] View billing and coding requirements for Lumbar MRI LCD.
Billing and Coding: Lymphedema Decongestive Treatment [PDF] View coverage and billing requirements for Lymphedema Decongestive Treatment Coverage.
Billing and Coding: Measurement of Salivary Hormones [PDF] View billing and coding requirements for the Measurement of Salivary Hormones LCD.
Billing and Coding: Medical Necessity of Therapy Services [PDF] View coverage and billing requirements for Medical Necessity of Therapy Services Coverage.
Billing and Coding: Micro-Invasive Glaucoma Surgery (MIGS) [PDF] View billing and coding requirements for Micro-Invasive Glaucoma Surgery (MIGS) LCD.
Billing and Coding: Mohs Micrographic Surgery [PDF] View billing and coding requirements for Mohs Micrographic Surgery LCD.
Billing and Coding: MolDX HAX1 Gene Sequencing [PDF] View billing and coding requirements for HAX1 Gene Sequencing.
Billing and Coding: MolDX Testing of Multiple Genes [PDF] View billing and coding requirements for MolDX: Testing of Multiple Genes.
Billing and Coding: MolDX: 4K Score Assay [PDF] View billing and coding requirements for the MolDX: 4K Score Assay LCD.
Billing and Coding: MolDX: 4q25-AF Risk Genotype [PDF] View billing and coding requirements for 4q25-AF Risk Genotype testing.
Billing and Coding: MolDX: 9p21 Genotype Test [PDF] View billing and coding requirements for 9p21 Genotype testing.
Billing and Coding: MolDX: Abbott RealTime IDH2 testing for Acute Myeloid Leukemia (AML) [PDF] 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 [PDF] View billing and coding requirements for the Afirma Assay by Veracyte.
Billing and Coding: MolDX: AlloMap [PDF] View billing and coding requirements for the Allomap testing.
Billing and Coding: MolDX: AlloSure® Donor-Derived Cell-Free DNA Test [PDF] View billing and coding requirements for the MolDX: AlloSure® Donor-Derived Cell-Free DNA Test LCD.
Billing and Coding: MolDX: APC and MUTYH Gene Testing [PDF] View billing and coding requirements for the MolDX: APC and MUTYH Gene Testing LCD.
Billing and Coding: MolDX: ApoE Genotype Billing and Coding Guidelines [PDF] View coverage and billing guidelines for ApoE Genotype testing.
Billing and Coding: MolDX: Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C) Testing [PDF] View billing and coding requirements for Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C) Testing
Billing and Coding: MolDX: Aspartoacyclase 2 Deficiency (ASPA) Testing [PDF] View billing and coding requirements for Aspartoacyclase 2 Deficiency (ASPA) Testing
Billing and Coding: MolDX: ATP7B Gene Tests [PDF] View billing and coding requirements for  ATP7B gene testing.
Billing and Coding: MolDX: Avise PG Assay [PDF] View billing and coding requirements for the MolDX:Avise PG Assay LCD.
Billing and Coding: MolDX: BCKDHB Gene Test [PDF] View billing and coding requirements for BCKDHB Gene Testing.
Billing and Coding: MolDX: BCR-ABL [PDF] View billing and coding requirements for MolDX: BCR-ABL.
Billing and Coding: MolDX: BDX-XL2 [PDF] View billing and coding requirements for the MolDX: BDX-XL2 LCD
Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment [PDF] View billing and coding requirements for the LCD
Billing and Coding: MolDX: bioTheranostics Cancer TYPE ID® [PDF] View billing and coding requirements for the MolDX:bioTheranostics Cancer Type ID® LCD.
Billing and Coding: MolDX: BLM Gene Analysis [PDF] View billing and coding requirements for BLM Gene Analysis.
Billing and Coding: MolDX: BluePrint® [PDF] View billing and coding requirements for BluePrint®.
Billing and Coding: MolDX: BRCA1 and BRCA2 Genetic Testing [PDF] View billing and coding requirements for the MolDX: BRCA1 and BRCA2 Genetic Testing  LCD.
Billing and Coding: MolDX: Breast Cancer Assay: Prosigna [PDF] View billing and coding requirements for the MolDX: Breast Cancer Assay: Prosigna LCD.
Billing and Coding: MolDX: Breast Cancer IndexTM (BCI) Gene Expression Test [PDF] View billing and coding requirements for the MolDX: Breast Cancer IndexTM (BCI) Gene Expression Test LCD.
Billing and Coding: MolDX: CDH1 Genetic Testing [PDF] View billing and coding requirements for MolDX CDH1 Genetic Testing
Billing and Coding: MolDX: CHD7 Gene Analysis [PDF] 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: Circulating Tumor Cell Marker Assays [PDF] View billing and coding requirements for the MolDX: Circulating Tumor Cell Marker Assays LCD.
Billing and Coding: MolDX: Clonoseq® Assay for Assessment of Minimal Residual Disease (MRD) in Patients with Specific Lymphoid Malignancies [PDF] 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 [PDF] View billing and coding requirements for the MolDX: ConfirmMDx Epigenetic Molecular Assay LCD.
Billing and Coding: MolDX: Corus CAD® Assay [PDF] View billing and coding requirements for the MolDX: Corus CAD® Assay LCD.
Billing and Coding: MolDX: Cystatin C Measurement [PDF] View billing and coding requirements for MolDX: Cystatin C Measurement LCD.
Billing and Coding: MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Very Low and Low Risk Disease [PDF] View billing and coding requirements for MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Very Low and Low Risk Disease LCD.
Billing and Coding: MolDX: Decipher® Prostate Cancer Classifier Assay [PDF] View billing and coding requirements for the MolDX: Decipher® Prostate Cancer Classifier Assay LCD.
Billing and Coding: MolDX: DecisionDX-Melanoma [PDF] View billing and coding requirements for the MolDX: DecisionDX-Melanoma LCD.
Billing and Coding: MolDX: DecisionDX-UM (Uveal Melanoma) [PDF] View billing and coding requirements for the MolDX: DecisionDX-UM (Uveal Melanoma) LCD.
Billing and Coding: MolDX: EndoPredict® Breast Cancer Gene Expression Test [PDF] View billing and coding requirements for the MolDX: EndoPredict® Breast Cancer Gene Expression Test LCD.
Billing and Coding: MolDX: ENG and ACVRL1 Gene Tests [PDF] View billing and coding requirements for ENG and ACVRL1 Gene Tests.
Billing and Coding: MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test [PDF] View billing and coding requirements for the MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test LCD.
Billing and Coding: MolDX: FANCC Genetic Testing [PDF] View billing and coding guidelines for FANCC Genetic testing.
Billing and Coding: MolDX: FDA Approved CLL Companion Diagnostic Test [PDF] View coverage and billing requirements for MolDX: FDA Approved CLL Companion Diagnostic Testing
Billing and Coding: MolDX: FDA-Approved BRAF Tests [PDF] View billing and coding requirements for FDA-Approved BRAF testing.
Billing and Coding: MolDX: FDA-Approved EGFR Tests [PDF] View billing and coding requirements for the MolDX: FDA-Approved EGFR Tests LCD.
Billing and Coding: MolDX: FDA-Approved KRAS Tests [PDF] View billing and coding requirements for the MolDX: FDA-Approved KRAS LCD.
Billing and Coding: MolDX: Fragile X Update [PDF] View billing and coding requirements for Fragile X.
Billing and Coding: MolDX: GBA Genetic Testing [PDF] View billing and coding requirements for Abbreviated Daytime Sleep Studies
Billing and Coding: MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease [PDF] 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) [PDF] 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 [PDF] View coverage and billing requirements for Lynch Syndrome Testing.
Billing and Coding: MolDX: Genomic Health™ Oncotype DX® Prostate Cancer Assay [PDF] View billing and coding requirements for the MolDX: Genomic Health™ Oncotype DX® Prostate Cancer Assay AND the MolDX: Oncotype DX® Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer.
Billing and Coding: MolDX: HBB Gene Tests [PDF] View billing and coding requirements for MolDX: HBB Gene Tests.
Billing and Coding: MolDX: HERmark Assay by Monogram [PDF] View billing and coding requirements for the MolDX: HERmark Assay by Monogram LCD.
Billing and Coding: MolDX: HEXA Gene Analysis [PDF] View billing and coding requirements for HEXA Gene Analysis 
Billing and Coding: MolDX: HLA-B*15:02 Genetic Testing [PDF] View billing and coding requirements for the MolDX: HLA-B*15:02 Genetic Testing LCD.
Billing and Coding: MolDX: HTTLPR Gene Testing [PDF] View billing and coding requirements for HTTLPR gene testing.
Billing and Coding: MolDX: IKBKAP Genetic Testing [PDF] View billing and coding requirements for MolDX: IKBKAP Genetic Testing.
Billing and Coding: MolDX: Immunohistochemistry (IHC) Indication for Breast Pathology [PDF] 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 [PDF] View billing and coding requirements for MolDX: Inivata, InVisionFirst, Liquid Biopsy for Patients with Lung Cancer LCD.
Billing and Coding: MolDX: KIF6 Genotype [PDF] View billing and coding requirements for KIF6 genotype testing.
Billing and Coding: MolDX: Know Error Update [PDF] View updated billing and coding requirements for MolDX: Know error.
Billing and Coding: MolDX: L1CAM Gene Sequencing [PDF] View coverage and billing requirements for MolDX: L1CAM Gene Sequencing.
Billing and Coding: MolDX: LPA-Aspirin Genotype [PDF] View billing and coding requirements for MolDX: LPA-Asprin Genotype testing.
Billing and Coding: MolDX: LPA-Intron 25 Genotype [PDF] View billing and coding requirements for MolDX: LPA-Intron 25 Genotype testing.
Billing and Coding: MolDX: MammaPrint [PDF] View billing and coding requirements for the MolDX: MammaPrint LCD.
Billing and Coding: MolDX: MCOLN1 Genetic Testing [PDF] There is insufficient evidence to support the required clinical utility for the established Medicare benefit category.
Billing and Coding: MolDX: MDS FISH [PDF] View billing and coding requirements for MolDX: MDS FISH LCD.
Billing and Coding: MolDX: MECP2 Genetic Testing [PDF] View billing and coding requirements for MECP2 Genetic Testing.
Billing and Coding: MolDX: MGMT Promoter Methylation Analysis [PDF] 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 [PDF] 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 [PDF] View billing and coding requirements for MolDX: Minimal Residual Disease Testing.
Billing and Coding: MolDX: Mitochondrial Nuclear Gene Tests [PDF] View updated coverage and billing requirements for MolDX: Mitochondrial Nuclear Gene Tests.
Billing and Coding: MolDX: MMACHC Test Billing and Coding Guidelines [PDF] View billing and coding guidelines for MolDX: MMACHC testing
Billing and Coding: MolDX: Molecular Diagnostic Tests (MDT) [PDF] 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 [PDF] View billing and coding requirements for MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels LCD.
Billing and Coding: MolDX: myPap Update [PDF] View updated billing and coding requirements for MolDX: myPap Tests.
Billing and Coding: MolDX: Myriad's BRACAnalysis CDx™ [PDF] View billing and coding requirements for the MolDX: Myriad's BRACAnalysis CDx™ LCA.
Billing and Coding: MolDX: NRAS Genetic Testing [PDF] View billing and coding requirements for the MolDX: NRAS Genetic Testing LCD.
Billing and Coding: MolDX: NSD1 Gene Tests [PDF] View coverage and billing requirements for MolDX: NSD1 Gene Tests.
Billing and Coding: MolDX: OncoCee [PDF] View billing and coding requirements for MolDX: OncoCee.
Billing and Coding: MolDX: Oncotype DX AR-V7 Nucleus Detect for Men with Metastatic Castrate Resistant Prostate cancer (MCRPC) [PDF] View billing and coding requirements for the MolDX: Oncotype DX AR-V7 Nucleus Detect for Men with Metastatic Castrate Resistant Prostate cancer (MCRPC) LCD.
Billing and Coding: MolDX: Oncotype DX® Breast Cancer Assay [PDF] 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™ [PDF] 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 [PDF] View billing and coding requirements for the MolDX: OncotypeDX® Colon Cancer Assay LCD.
Billing and Coding: MolDX: PAX6 Gene Sequencing [PDF] View billing and coding guidelines for MolDX: PAX6 Gene Sequencing
Billing and Coding: MolDX: Percepta© Bronchial Genomic Classifier [PDF] View billing and coding requirements for the MolDX: Percepta© Bronchial Genomic Classifier LCD.
Billing and Coding: MolDX: Pharmacogenomics Testing [PDF] View Billing and Coding requirements for Billing and Coding: MolDX: Pharmacogenomics Testing LCD.
Billing and Coding: MolDX: PIK3CA Gene Tests [PDF] View billing and coding requirements for MolDX: PIK3CA Gene Tests.
Billing and Coding: MolDX: Predictive Classifiers for Early Stage Non-Small Cell Lung Cancer [PDF] View Billing and Coding requirements for the MolDX: Predictive Classifiers for Early Stage Non-Small Cell Lung Cancer LCD.
Billing and Coding: MolDX: PreDx® [PDF] View billing and coding requirements for MolDX: PreDx®.
Billing and Coding: MolDX: Progensa® PCA3 Assay [PDF] View billing and coding requirements for the MolDX: Progensa® PCA3 Assay LCD.
Billing and Coding: MolDX: Prolaris Cancer Genomic Assay [PDF] 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 [PDF] 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 [PDF] View billing and coding requirements for MolDX: ProMark Risk Score LCD.
Billing and Coding: MolDX: Prometheus IBD sgi Diagnostic Policy [PDF] View billing and coding requirements for the MolDX: Prometheus IBD sgi Diagnostic Policy LCD.
Billing and Coding: MolDX: PTCH1 Gene Testing [PDF] View billing and coding requirements for MolDX: PTCH1 Gene Testing.
Billing and Coding: MolDx: ResponseDX Tissue of Origin® [PDF] View billing and coding requirements for the MolDX: ResponseDX Tissue of Origin® LCD.
Billing and Coding: MolDX: RPS19 Gene Tests [PDF] View coverage and billing requirements for MolDX: RPS19 Gene Tests.
Billing and Coding: MolDX: SETP9 Gene Test Billing and Coding Guidelines [PDF] View billing and coding guidelines for MolDX: SETP9 Gene Tests
Billing and Coding: MolDX: SMPD1 Genetic Testing [PDF] 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 [PDF] There is insufficient evidence to support the required clinical utility for the established Medicare benefit category.
Billing and Coding: MolDX: SULT4A1 Genetic Testing [PDF] 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 [PDF] View coverage and billing requirements for Targeted and Comprehensive Genomic Profile Next-Generation Sequencing Testing in Cancer.
Billing and Coding: MolDX: TERC Gene Tests [PDF] View billing and coding requirements for MolDX: TERC Gene Tests.
Billing and Coding: MolDX: ThermoFisher Oncomine Dx Target Test for Non-Small Cell Lung Cancer [PDF] 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 [PDF] View coverage and billing requirements for the TP53 Gene Test
Billing and Coding: MolDX: TruGraf Blood Gene Expression Test [PDF] View billing and coding requirements for MolDX: TruGraf Blood Gene Expression Test.
Billing and Coding: MolDX: Vectra™ DA [PDF] View billing and coding requirements for the MolDX: Vectra™ DA LCD.
Billing and Coding: MolDX: VEGFR2 Tests [PDF] View billing and coding guidelines for MolDX: VEGFR2
Billing and Coding: Molecular RBC Phenotyping [PDF] View billing and coding requirements for Molecular RBC Phenotyping LCD.
Billing and Coding: Mometasone Furoate Sinus Implant (Sinuva, Propel family of Implants) [PDF] View billing and coding requirements for Sinuva and Propel family of sinus Implants
Billing and Coding: MRI and CT Scans of the Head and Neck [PDF] 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 [PDF] View billing and coding requirements for Nerve Blockade for Treatment of Chronic Pain and Neuropathy LCD.
Billing and Coding: Nerve Conduction Studies and Electromyography [PDF] View billing and coding requirements for the Nerve Conduction Studies and Electromyography LCD.
Billing and Coding: Outpatient Therapy Biofeedback Training [PDF] View Medicare coverage and billing of Outpatient Therapy Biofeedback Training. 
Billing and Coding: Patients Supplied Donated or Free-of-Charge Drug [PDF] 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) [PDF] View billing and coding requirements for Percutaneous Vertebral Augmentation LCD.
Billing and Coding: Peripheral Nerve Stimulation [PDF] View billing and coding requirements for Peripheral Nerve Stimulation LCD.
Billing and Coding: Piriformis Injections [PDF] View coverage and billing requirements for Piriformis Injections Coverage.
Billing and Coding: Plastic Surgery [PDF] View billing and coding requirements for Plastic Surgery Policy.
Billing and Coding: Platelet Rich Plasma [PDF] View coverage and billing requirements for Billing and Coding: Platelet Rich Plasma Coverage.
Billing and Coding: Polysomnography and Other Sleep Studies [PDF] View billing and coding requirements for Polysomnography and Other Sleep Studies LCD.
Billing and Coding: Posterior Tibial Nerve Stimulation Coverage [PDF] View coverage and billing requirements for Posterior Tibial nerve Stimulation Coverage.
Billing and Coding: Prospera™ [PDF] View coverage and billing requirements for Prospera™.
Billing and Coding: Pulmonary Rehabilitation Services [PDF] 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: Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder [PDF] 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 [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.
Billing and Coding: Respiratory Care (Respiratory Therapy) [PDF] View billing and coding requirements for Respiratory Care (Respiratory Therapy) LCD.
Billing and Coding: Routine Dental Services [PDF] ICD-10-CM codes that are considered routine dental services and are non covered.
Billing and Coding: Routine Foot Care [PDF] View coverage and billing requirements for Billing and Coding: Routine Foot Care Coverage.
Billing and Coding: Sclerosing of Varicose Veins [PDF] View information regarding incorrect coding for CPT 37241 for varicose vein ablation.
Billing and Coding: Serum Magnesium [PDF] View billing and coding requirements for Serum Magnesium LCD.
Billing and Coding: Spinal Cord Stimulators for Chronic Pain [PDF] View billing and coding requirements for Spinal Cord Stimulators for Chronic Pain LCD.
Billing and Coding: Spinal Fusion Services: Documentation Requirements [PDF] View clarification of medical necessity and documentation requirements.
Billing and Coding: Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT) [PDF] View billing and coding requirements for the Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT) LCD.
Billing and Coding: Testopel Coverage [PDF] View coverage guidelines for Testopel pellets.
Billing and Coding: Therapy Driving Evaluations [PDF] View Medicare coverage and billing guide for Therapy Driving Evaluations.
Billing and Coding: Therapy Evaluation, Re-Evaluation and Formal Testing [PDF] View coverage and billing requirements for Therapy Evaluation and Formal Testing Coverage.
Billing and Coding: Therapy Evaluation Coding [PDF] View coverage and billing requirements for Therapy Evaluation Coding Coverage.
Billing and Coding: Therapy Students and Aides [PDF] View coverage and billing requirements for Therapy Students and Aides Coverage.
Billing and Coding: Tomosynthesis-Guided Breast Biopsy [PDF] View billing and coding requirements for Tomosynthesis-Guided Breast Biopsy.
Billing and Coding: Topical HBO and Physician Related Service Billing and Coding Guidelines [PDF] View coverage and billing requirements for Topical HBO and Physician Related Service Billing and Coding Guidelines
Billing and Coding: Total Hip Arthroplasty [PDF] View billing and coding requirements for Total Hip Arthroplasty LCD.
Billing and Coding: Total Knee Arthroplasty [PDF] View billing and coding requirements for Total Knee Arthroplasty LCD.
Billing and Coding: Treatment of Males with Low Testosterone [PDF] View Billing and Coding requirements for Treatment of Males with Low Testosterone LCD.
Billing and Coding: Treatment of Ulcers and Symptomatic Hyperkeratoses [PDF] View billing and coding requirements for Treatment of Ulcers and Symptomatic Hyperkeratoses LCD.
Billing and Coding: Treatment of Varicose Veins of the Lower Extremities [PDF] View billing and coding requirements for Treatment of Varicose Veins of the Lower Extremities LCD.
Billing and Coding: Treatment with Yttrium-90 Microspheres [PDF] View coverage and billing requirements for Yttrium-90 Microspheres.
Billing and Coding: Trigger Point Injections [PDF] View Billing and Coding requirements for Trigger Point Injections LCD.
Billing and Coding: Vitamin D Assay Testing [PDF] 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 [PDF] 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 [PDF] View Zika Virus billing and coverage information
Cosmetic vs. Reconstructive Surgery Coverage View clarification of Medicare coverage and defines cosmetic versus reconstructive surgical procedures.
Dropless Cataract Surgery [PDF] 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.
Investigational Device Exemptions (IDE) - IDE Documentation Requirements for Studies with an FDA Approval dated January 01, 2015 or Later [PDF] 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 [PDF] View coverage and billing guidelines for non-payment of prefabricated splints.
Noncoverage of Peripheral Nerve Field Stimulation - Coding and Billing [PDF] View coverage and billing requirements for Noncoverage of Peripheral Nerve Field Stimulation – Coding and Billing.
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 [PDF] 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 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 [PDF] View clarification for coverage criteria for Prostate Cancer
Therapeutic Apheresis for Familial Hypercholesterolemia [PDF] View coverage information for therapeutic apheresis in the treatment of refractory familial hypercholesterolemia.
Use of Amniotic Membrane Derived Skin Substitutes [PDF] Clinical use of amniotic membrane derived skin substitutes outside of the care of DSU and VSU as not reasonable and necessary and non-covered.
Waiver of Face-to-Face Visit for Home Dialysis Patients – Coding and Billing [PDF] View coding guidelines to request waiver with 52 modifier to the appropriate monthly capitation CPT codes 90963-90966.

 

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Last Updated Wed, 25 Nov 2020 20:40:44 +0000