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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.

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 Specialty, be sure to look there.

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Topic Brief Description
Abbreviated Daytime Sleep Study (e.g. PAP-NAP) View coverage and billing requirements for Abbreviated Daytime Sleep Studies
Billing Medicare for the SphenoCath® Device View coverage and billing requirements for Billing Medicare for the SphenoCath® Device Coverage.
Bladder Tumor Marker FISH Billing and Coding Guidelines View coverage and billing requirements for Bladder Tumor Marker FISH Billing and Coding Guidelines Coverage.

Chemotherapy Administration

View coverage and billing requirements for Chemotherapy Administration Coverage.

DecisionDX-UM Billing Guidelines View billing guidelines for DecsionDx-UM™
Dropless Cataract Surgery View coverage and billing information for Dropless Cataract Surgery. 
Fracture Care Coding for Physicians 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.
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 coverage and billing requirements for Hydration Services Coverage.
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  Coverage and billing requirements for off-label use of bevacizumab for intravitreal injection. 
Investigational Device Exemptions (IDEs) View this page for 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.
MolDX: FDA Approved ALK Companion Diagnostic Tests Billing and Coding Guidelines View billing and coding guidelines for MolDX: FDA approved ALK testing
MolDX: L1CAM Gene Sequencing Billing and Coding Guidelines View coverage and billing requirements for MolDX: L1CAM Gene Sequencing.
MolDX: MCOLN1 Genetic Testing Billing and Coding Guidelines There is insufficient evidence to support the required clinical utility for the established Medicare benefit category.
MolDX: PIK3CA Gene Tests Billing and Coding Guidelines View coverage and billing requirements for MolDX: PIK3CA Gene Tests.
MolDX: PTCH1 Gene Testing Billing and Coding Guidelines View coverage and billing requirements for MolDX: PTCH1 Gene Testing.
MolDX: RPS19 Gene Tests Billing and Coding Guidelines View coverage and billing requirements for MolDX: RPS19 Gene Tests.
MolDX: STAT3 Gene Testing Billing and Coding Guidelines There is insufficient evidence to support the required clinical utility for the established Medicare benefit category.
MolDX: SULT4A1 Genetic Testing Billing and Coding Guidelines View coverage and billing requirements for MolDX: SULT4A1 Genetic Testing.
MolDX: TERC Gene Tests Billing and Coding Guidelines View coverage and billing requirements for MolDX: TERC Gene Tests.
MolDX: UGT1A1 Gene Analysis Billing and Coding Guidelines There is insufficient evidence to support the required clinical utility for the established Medicare benefit category.
MolDX: MMACHC Test Billing and Coding Guidelines View billing and coding guidelines for MolDX: MMACHC testing
MolDX: VEGFR2 Tests Coding and Billing Guidelines View coding and billing guidelines for MolDX: VEGFR2
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.
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
Response to Comments: MolDX: APC and MUTYH View comments and responses to draft LCD
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. 
Sleep Lab Credentialing: Polysomnography and Other Sleep Studies View Sleep Lab Credentialing for Polysomnography and Other Sleep Studies
Testopel Coverage 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

 

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

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Last Updated Aug 21, 2017