National Government Services Local Coverage Determinations and Medical Policy Articles for Jurisdiction 6
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1 Local Coverage Determinations and Medical Policy Articles for Jurisdiction 6 Have Been Posted Courtesy of J6 Medicare News National Government Services Local Coverage Determinations and Medical Policy Articles for Jurisdiction 6 The Centers for Medicare & Medicaid Services (CMS) selected National Government Services as the new Medicare Administrative Contractor (MAC) for Part A/B Jurisdiction 6 (J6). The J6 service area includes Part A and Part B providers in the states of Illinois, Minnesota, and Wisconsin, and National Government Services current HH+H and federally qualified health center (FQHC) providers. National Government Services will assume responsibility for J6 A/B MAC workload in segments based on geographic location/outgoing contractor. J6 local coverage determinations (LCDs) will become effective for services rendered on or after the date a provider's segment transitions to J6. What is an LCD? An LCD is a decision by a MAC, whether to cover, and under what circumstances to cover, a particular item or service in their jurisdiction in accordance with Section 1862(a) (1) (A) of the Social Security Act (i.e., a determination as to whether the item or service is reasonable and necessary). MACs develop and publish LCDs to provide guidance to the public and medical community within their jurisdictions. What are Supplemental Instruction Articles and Medical Policy Articles? Supplemental Instruction Articles (SIAs) and Medical Policy Articles are developed by MACs to provide guidance and instructions regarding billing and coding information to providers. SIAs usually relate to specific LCDs. Medical policy articles provide guidance for specific services that do not require a LCD. Where to find the LCDs, SIAs and Medical Policy Articles LCDs/SIAs and Medical Policy Articles will be posted on the National Government Services Web site at: On the home page click the J6 icon in the upper left corner to access the J6 transition Web site. Under the header, Transition information A-Z, click on Local Coverage Determinations/Supplemental Instruction Articles/Medical Policy Articles. A list of LCDs, SIAs and Medical Policy articles is provided with links to the documents. Changes that may affect former Noridian Administrative Services (NAS) and Wisconsin Physicians Service (WPS providers) All LCDs for NAS, WPS, and National Government Services were reviewed by the National Government Services Medical Policy staff to determine the most clinically appropriate policy.
2 There are sixty-two J6 LCDs for Part A, Part B, FQHC and HH+H providers. (A list of the sixty-two LCDs is provided below.) Seventeen of the J6 LCDs will be new for NAS and WPS providers. The column "new" in the table below indicates the LCDs that will be new policies for which NAS and WPS did not have a LCD. NAS LCDs The following NAS LCD was adopted by National Government Services and will apply to all J6 providers: L33390-Stereotactic Radiation Therapy, Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy is being retained The remaining NAS LCDs are being retired or replaced with other LCDs. WPS LCDs The following WPS LCDs were adopted by National Government Services and will apply to all J6 providers: L33371-Endoscopic Treatment of GERD L33384-Heavy Metal Testing L33385-Nerve Blocks for Peripheral Neuropathy L33386-Nerve Conduction Studies and Electromyography L33387-Proton Beam Therapy L33388-Radiofrequency Treatment for Urinary Incontinence L33389-Venous Angioplasty with or without Stent Placement for the Treatment of Chronic Cerebrospinal Venous Insufficiency The remaining WPS LCDs are being retired or replaced with other J6 LCDs. National Government Services will have sixty-two LCDs in J6 to assist providers in determining coverage of select Medicare services. Listed below are the J6 LCDs. LCDs for National Government Services J6: LCD ID LCD Title New LCD L26003 Biologic Products for Wound Treatment and Surgical Interventions L26841 Botulinum Toxins L26890 Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography Toxins New L26375 B-type Natriuretic Peptide (BNP) Testing
3 L26880 Cardiac Catheterization and Coronary Angiography L25907 Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA) L25447 Cardiac Output Measurement Thoracic Electrical Bioimpedance New L26859 L26853 L25275 L27350 L32965 Cardiovascular Nuclear Medicine Cataract Extraction Category III CPT Codes Chiropractic Services Circulating Tumor Cell (CTC) Assay L26404 Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy L32589 Combined Ovarian Cancer Biomarker Tests New L25233 Computed Tomographic (CT) Colonography L28142 L27373 Corneal Pachymetry Debridement Services L25820 Drugs and Biologicals, Coverage of, for Label and Off-Label Uses L32963 EEG - 24 Hour Monitoring New L33371 L25211 Endoscopic Treatment of GERD Erythropoiesis Stimulating Agents (ESA) L32977 Galectin-3 New L33384 L25678 Heavy Metal Testing Hospice - Determining Terminal Status L32454 Implantable Miniature Telescope (IMT) New L28490 Incision and Drainage (I&D) of Abscess of Skin, Subcutaneous and Accessory Structures New L25367 Magnetic Resonance Angiography (MRA) New L33385 Nerve Blocks for Peripheral Neuropathy L33386 Nerve Conduction Studies and Electromyography L32456 L27355 Non-Covered Pre-operative Services Non-Invasive Vascular Studies L28178 Nonvascular Extremity Ultrasound New L26441 Ophthalmic Biometry for Intraocular Lens Power Calculation L25466 Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography) New L32945 Osteopathic Manipulative Treatment New L26884 Outpatient Physical and Occupational Therapy Services L28529 Pain Management L28497 Panretinal (Scatter) Laser Photocoagulation New L28395 Percutaneous Coronary Intervention L31391 Posterior Tibial Nerve Stimulation for Voiding Dysfunction
4 L33387 Proton Beam Therapy L25507 Psychiatric Inpatient Hospitalization New L26398 Psychiatric Partial Hospitalization Programs L26895 L28145 Psychiatric and Psychology Services Qualitative Drug Screening L28463 RAST Type Tests New L27362 Removal of Benign Skin Lesions L26426 Routine Foot Care and Debridement of Nails L28488 Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI) L27404 Speech-Language Pathology New L33390 L32038 L27381 Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT) Transcranial Magnetic Stimulation Transesophageal Echocardiography (TEE) L26876 Transrectal Ultrasound New L27360 Transthoracic Echocardiography (TTE) L26851 Urodynamics New L25519 Varicose Veins of the Lower Extremity, Treatment of L33389 Venous Angioplasty With or Without Stent Placement for the Treatment of Chronic Cerebrospinal Venous Insuffiency L26439 Vertebroplasty and Kyphoplasty (Percutaneous) L26367 L29510 Visual Fields Testing Vitamin D Assay Test Medical Policy Articles not associated with an LCD: SIA ID A48361 A51525 A51974 A49286 A48292 A50548 A51614 A49058 SIA Title Arthroscopic Lavage and Arthroscopic Debridement for the Osteoarthritic Knee Blephroplasty Bone Mass Measurement Clinical Trials Collagen Implantation for Urinary Incontinence Colorectal Cancer Screening Coverage and Billing FDG Positron Emission Tomography (PET) Scans CPT Code (Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, methicillin resistant, amplified probe technique)
5 SIA ID A51630 A48209 A52174 A48210 A45910 A51967 A47355 A46071 A51667 A52210 A47521 A51723 A2311 A50641 A51834 A51789 A49710 SIA Title Dialysis Access Maintenance Health and Behavior Assessment/Intervention Hyperbaric Oxygen (HBO) Therapy Initial Hospital Care Visits Investigational Device Exemption Requests Laparoscopic Sleeve Gastrectomy (LSG) Local Coverage Determination (LCD) Reconsideration Process Medical Nutrition Therapy (MNT) Services Ocular Blood Flow Tests Polysomnography and Sleep Studies Process for Determining Self-Administered Drug Exclusions Psychological Services Coverage under the Incident to Provision for Physicians and Non-physicians Self-Administered Drug Exclusion List Skilled Nursing Facilities (Including Swing Beds) Stem Cell Transplantation Surveillance of Implantable or Wearable Cardioverter Defibrillators (ICDs): Office, Hospital, Web, or Non-Web Based Tetanus Immunization
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