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 CPT/HCPCS Codes Referenced
Billing and Coding: Abbreviated Daytime Sleep Study (e.g. PAP-NAP) A55479 N/A
Billing and Coding: Arthroscopic Lavage and Arthroscopic Debridement for Osteoarthritic Knees A54063 29871
Billing and Coding: Bariatric Surgery Coverage A53028 43644, 43645, 43770, 43775, 43845, 43846, 43847
Billing and Coding: Billing Limitations for Pharmacies A56124 90630, 90653, 90654, 90655, 90656, 90657, 90658, 90660, 90661, 90662, 90664, 90666, 90667, 90668, 90670, 90672, 90673, 90674, 90682, 90685, 90686, 90687, 90688, 90689, 90732, 90756, G0008, G0009, J7170, J7180, J7181, J7182, J7183, J7185, J7186, J7187, J7188, J7189, J7190, J7191, J7192, J7193, J7194, J7195, J7198, J7199, J7200, J7201, J7202, J7205, J7212, J7214
Billing and Coding: Billing Medicare for the SphenoCath and Other Similar Devices A55585 64999
Billing and Coding: Chiropractic Services A57914 98940, 98941, 98942
Billing and Coding: Fracture Care A52767 N/A
Billing and Coding: Guardant360® A58214 81479
Billing and Coding: Home PT/INR Monitoring (G0249) Billing and Coding A55756 G0249
Billing and Coding: Hydration Services A52732 96360, 96361
Billing and Coding: Implantable Automatic Defibrillators A56342 33202, 33203, 33215, 33216, 33217, 33218, 33220, 33223, 33224, 33225, 33230, 33231, 33240, 33241, 33243, 33244, 33249, 33262, 33263, 33264, 33270, 33271, 33272, 33273, C7537, C7538, C7539, C7540, G0448
Billing and Coding: Implantable Infusion Pumps for Chronic Pain A55323 62325, 62327, 62350, 62351, 62355, 62360, 62361, 62362, 62365, 62367, 62368, 62369, 62370, 95990, 95991, J7999
Billing and Coding: Incident To Clarification for OPPS and CAH Outpatient A55214 N/A
Billing and Coding: Influenza Diagnostic Tests A59056 87252, 87253, 87254, 87275, 87286, 87400, 87501, 87502, 87503, 87804
Billing and Coding: Intensity Modulated Radiation Therapy (IMRT) A58245 77385, 77386, G6015, G6016
Billing and Coding: Intraocular Bevacizumab A53009 67028, 92134, C9257, J7999, Q5129
Billing and Coding: IUD (Hormone-Eluting) for Endometrial Hyperplasia - CPT 58999 A55062 58999
Billing and Coding: JW and JZ Modifier Billing Guidelines A55932 N/A
Billing and Coding: Lymphedema Decongestive Treatment A52959 29581, 29584, 97140, 97535
Billing and Coding: Medical Necessity of Therapy Services A52775 97161, 97162, 97163, 97165, 97166, 97167
Billing and Coding: MolDX: 4q25-AF Risk Genotype A55091 81479
Billing and Coding: MolDX: 9p21 Genotype Test A55093 81479
Billing and Coding: MolDX: Aspartoacyclase 2 Deficiency (ASPA) Testing A55089 81200, 81412, 81443, 81479
Billing and Coding: MolDX: ATP7B Gene Tests A55098 81406, 81443, 81479
Billing and Coding: MolDX: BCKDHB Gene Test A55100 81205, 81406, 81443
Billing and Coding: MolDX: BLM Gene Analysis A55114 81209, 81443
Billing and Coding: MolDX: BluePrint® A55116 81479
Billing and Coding: MolDX: CDH1 Genetic Testing A55971 81406
Billing and Coding: MolDX: CHD7 Gene Analysis A55086 81407, 81479
Billing and Coding: MolDX: ENG and ACVRL1 Gene Tests A55182 81405, 81406, 81479
Billing and Coding: MolDX: FANCC Genetic Testing A55184 81242, 81412, 81443
Billing and Coding: MolDX: FDA Approved CLL Companion Diagnostic Test A56013 88271, 88275, 88291, 88374, 88377
Billing and Coding: MolDX: Fragile X A55242 81243, 81244, 81470, 81471
Billing and Coding: MolDX: GBA Genetic Testing A55244 81251
Billing and Coding: MolDX: HAX1 Gene Sequencing A55252 81479
Billing and Coding: MolDX: HBB Gene Tests A55254 81361, 81362, 81363, 81364, 81443
Billing and Coding: MolDX: HEXA Gene Analysis A55256 81255, 81406, 81412, 81443
Billing and Coding: MolDX: HLA Testing for Transplant Histocompatibility A57972 81370, 81371, 81372, 81373, 81375, 81376, 81378, 81379, 81380, 81382
Billing and Coding: MolDX: HTTLPR Gene Testing A55265 81479
Billing and Coding: MolDX: IKBKAP Genetic Testing A55613 81260, 81412, 81443
Billing and Coding: MolDX: KIF6 Genotype A55273 81479
Billing and Coding: MolDX: Know Error A55275 84999
Billing and Coding: MolDX: L1CAM Gene Sequencing A55278 81407, 81470, 81471
Billing and Coding: MolDX: LPA-Aspirin Genotype A55280 81479
Billing and Coding: MolDX: LPA-Intron 25 Genotype A55282 81479
Billing and Coding: MolDX: MCOLN1 Genetic Testing A55284 81290, 81412, 81443
Billing and Coding: MolDX: MECP2 Genetic Testing A55286 81302, 81303, 81304, 81470, 81471, 81479
Billing and Coding: MolDX: Mitochondrial Nuclear Gene Tests A55291 81479
Billing and Coding: MolDX: MMACHC Test A55289 81404
Billing and Coding: MolDX: myPap A55293 84999
Billing and Coding: MolDX: NSD1 Gene Tests A55615 81405, 81406, 81479
Billing and Coding: MolDX: PAX6 Gene Sequencing A55632 81479
Billing and Coding: MolDX: PIK3CA Gene Tests A55602 81309, 0155U
Billing and Coding: MolDX: PTCH1 Gene Testing A55618 81479
Billing and Coding: MolDX: RPS19 Gene Tests A55614 81405, 81479
Billing and Coding: MolDX: SEPT9 Gene Test A55628 81327
Billing and Coding: MolDX: SMPD1 Genetic Testing A55631 81330, 81412
Billing and Coding: MolDX: STAT3 Gene Testing A55481 81405
Billing and Coding: MolDX: SULT4A1 Genetic Testing A55601 81479
Billing and Coding: MolDX: TERC Gene Tests A55616 81479
Billing and Coding: MolDX: Testing of Multiple Genes A58121 N/A
Billing and Coding: MolDX: TP53 Gene Test Billing and Coding Guidelines A55487 81351, 81352
Billing and Coding: MolDX: VEGFR2 Tests A55469 81479
Billing and Coding: Outpatient Therapy Biofeedback Training A52755 90901, 90912, 90913
Billing and Coding: Patients Supplied Donated or Free-of-Charge Drug A55045 N/A
Billing and Coding: Piriformis Injections A56028 20552
Billing and Coding: Positron Emission Tomography Scans Coverage A54668 78429, 78430, 78431, 78432, 78433, 78434, 78459, 78491, 78492, 78608, 78609, 78811, 78812, 78813, 78814, 78815, 78816, A4641, A9515, A9526, A9552, A9555, A9580, A9586, A9587, A9588, A9591, A9592, A9593, A9594, A9595, A9596, A9597, A9598, A9602, A9800, G0235, Q9982, Q9983
Billing and Coding: Pulmonary Rehabilitation Services A52770 94625, 94626, G0237, G0238, G0239
Billing and Coding: Reporting a Non-Covered Test Performed in Preparation for a Non-Covered Procedure A55775 92025
Billing and Coding: Routine Foot Care A57957 11055, 11056, 11057, 11719, 11720, 11721, G0127
Billing and Coding: Sacral Nerve Stimulation for Urinary and Fecal Incontinence A53017 64561, 64581, 64585, 64590, 64595, A4290, C1767, C1778, C1820, C1883, C1897, L8680
Billing and Coding: Short Tandem Repeat (STR) Markers and Chimerism (CPT® codes 81265-81268) A57843 81265, 81266, 81267, 81268
Billing and Coding: Single Chamber and Dual Chamber Permanent Cardiac Pacemakers - Coding and Billing A54931 33206, 33207, 33208
Billing and Coding: Spinal Fusion Services: Documentation Requirements A53975 N/A
Billing and Coding: Spinraza® (Nusinersen) A58579 J2326
Billing and Coding: Therapy Driving Evaluations A52772 N/A
Billing and Coding: Therapy Evaluation Coding A55367 N/A
Billing and Coding: Therapy Evaluation, Re-Evaluation and Formal Testing A52773 95851, 95852, 97161, 97162, 97163, 97164, 97165, 97166, 97167, 97168, 97750
Billing and Coding: Therapy Students and Aides A52776 N/A
Billing and Coding: Tomosynthesis-Guided Breast Biopsy A57849 19081, 19082, 19083, 19084, 19085, 19086, 19100, 19101, 19281, 19282, 19283, 19284, 19285, 19286, 19287, 19288, 19499, 76098, 76376, 76377, 77011, 77053, 77054, 77061, 77062, 77063, 77065, 77066, 77067, C7501, C7502, G0279
Billing and Coding: Topical HBO and Physician Related Service Billing and Coding Guidelines A56026 99199, A4575, E0446
Billing and Coding: Wound Care & Debridement-Provided by a Therapist, Physician, NPP or as Incident-to Services A53046 29580, 97022, 97161, 97162, 97153, 97597, 97598, 97602, G0463
Billing and Coding: Zika Virus Testing by PCR and ELISA Methods A55327 86790, 86794, 87662, 87798, 87801
Dropless Cataract Surgery A53918 N/A
Investigational Device Exemptions (IDE) - IDE Documentation Requirements for Studies with an FDA Approval dated January 01, 2015 or Later A54917 N/A
MolDX: Algorithm definition as a component of a laboratory test A58674 N/A
Non-Payment for Prefabricated Splints A52754 N/A
Pegfilgrastim (Neulasta) J2505 A55447 N/A
Post Market Studies and Post Market Extension Studies - Percutaneous Transluminal Angioplasty (PTA) with Carotid Stenting and Embolic Protection N/A N/A
Sipuleucel-T (Provenge®) - Coverage Criteria for Prostate Cancer - Clarification A52926 Q2043
Sterilization A52960 55250, 58600, 58605, 58611, 58615, 58670, 58671
Therapeutic Apheresis for Familial Hypercholesterolemia A54545 36516
Waiver of Face-to-Face Visit for Home Dialysis Patients A55059 N/A

 

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Last Updated Dec 15 , 2023