Billing and Coding 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: 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: Leadless Pacemakers A59828 33274, 0823T, 0795T, 0796T, 0797T, 0801T, 0802T, 0803T
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: ApoE Genotype A55095 81401
Billing and Coding: MolDX: bioTheranostics Cancer TYPE ID® A54388 81540
Billing and Coding: MolDX: BluePrint® A55116 81479
Billing and Coding: MolDX: FDA-Approved BRAF Tests A54420 81210
Billing and Coding: MolDX: FDA Approved CLL Companion Diagnostic Test A56013 88271, 88275, 88291, 88374, 88377
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: PIK3CA Gene Tests A55602 81309, 0155U
Billing and Coding: MolDX: Prometheus® IBD sgi Diagnostic® Policy A57517 81479
Billing and Coding: MolDX: Proteomics Testing A59642 81490, 81500, 81503, 81517, 81539, 81599, 0002M, 0003M, 0015M, 0019M, 0002U, 0003U, 0021U, 0080U, 0092U, 0095U, 0105U, 0117U, 0174U, 0206U, 0207U, 0228U, 0249U, 0259U, 0263U, 0295U, 0308U, 0309U, 0310U, 0312U, 0322U, 0344U, 0351U, 0360U, 0365U, 0366U, 0367U, 0375U, 0384U, 0385U, 0387U, 0407U, 0412U, 0415U, 0436U, 0446U, 0447U
Billing and Coding: MolDX: SEPT9 Gene Test A55628 81327
Billing and Coding: MolDX: Short Tandem Repeat (STR) Markers and Chimerism (CPT® codes 81265-81268) A57843 81265, 81266, 81267, 81268
Billing and Coding: MolDX: SULT4A1 Genetic Testing A55601 81479
Billing and Coding: MolDX: Targeted and Comprehensive Genomic Profile Testing in Cancer A56518 N/A
Billing and Coding: MolDX: Testing of Multiple Genes A58121 N/A
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: 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: 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
MolDX: Clarification of Order Requirements for Laboratory and Molecular Diagnostic Services A59744 NA
MolDX: Defining panel services in MolDX A59687 N/A
Non-Payment for Prefabricated Splints A52754 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

To view all the articles on the CMS website, select a link below to be redirected to the MCD.

Last Updated Jun 12 , 2024