Local Coverage Determinations (LCDS) and Medical Policy Articles for Jurisdiction 6 National Government Services Will Become Effective With Implementation The Centers for Medicare & Medicaid Services (CMS) selected National Government Services (NGS) 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 NGS current HH+H and FQHC providers. National Government Services will assume responsibility for J6 A/B MAC workload in segments based on geographic location/outgoing contractor. Local Coverage Determinations (LCDs) will become effective for providers as their region is transitioned to National Government Services. What is an LCD? An LCD is a decision by a MAC, whether to cover a particular item or service for the region 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). Contractors develop and publish LCDs to provide guidance to the public and medical community within their jurisdictions. What are Supplemental Instructions Article (SIA) and Medical Policy Articles? SIAs and Medical Policy Articles are developed by contractors to give providers guidance and instructions regarding billing and coding information. SIAs usually relate to specific LCDS. Medical policy articles provide guidance for specific services that do not require a LCD. How to find the LCD s, SIAs and Medical Policy Articles LCDs/SIAs and Medical Policy Articles will be housed on the National Government Services website at: www.ngsmedicare.com. On the home page click the J6 icon in the upper left corner to enter the J6 transition website. Under the Header: Transition information A-Z, click on Local Coverage Determinations/Supplemental Instruction
Articles/Medical Policy Articles. A list of LCDs, SIA and Medical Policy articles are provided with links to the documents. Changes that may affect Providers from Noridian Administrative Services (NAS) and Wisconsin Physicians Service (WPS): All LCDS for NAS, WPS, and NGS were reviewed by Medical Policy at National Government Services. National Government Services will have sixty-two LCDs for the J- 6 region for Part A, Part B, FQHC and HH+H providers. A list of the sixty-two LCDs is provided below. Of the sixty-two LCDs seventeen of these policies 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 an LCD. Noridian The following LCD will be retained from Noridian and will apply to all J6 providers: L33390-Stereotactic Radiation Therapy, Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy is being retained All other LCDs from Noridian are being retired or replaced with other LCDs Wisconsin Physicians Service The following LCDs are being retained 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 National Government Services, Inc. Page 2 of 8
All other LCDs from Wisconsin Physicians Service are being retired or replaced with other LCDs National Government Services will have sixty two LCDs in J6 to assist providers in guidance and coverage of select Medicare services. Listed below are the LCDs that will be effective for J6 upon transition: Local Coverage Determinations for National Government Services J-6 LCD ID Number Supplemental Instructions Article ID Number LCD/Article Title L26003 A45056 Biologic Products for Wound Treatment and Surgical Interventions LCD L26841 A46164 Botulinum Toxins L26890 A48362 Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography L26375 N/A B-type Natriuretic Peptide (BNP) Testing L26880 A50603 Cardiac Catheterization and Coronary Angiography L25907 A45020 Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA) L25447 A44455 Cardiac Output Measurement Thoracic Electrical Bioimpedance L26859 N/A Cardiovascular Nuclear Medicine L26853 A46178 Cataract Extraction National Government Services, Inc. Page 3 of 8
L25275 A46075 Category III CPT Codes L27350 A47385 Chiropractic Services L32965 N/A Circulating Tumor Cell (CTC) Assay L26404 A45926 Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy L32589 N/A Combined Ovarian Cancer Biomarker Tests L25233 N/A Computed Tomographic (CT) Colonography L28142 A48393 Corneal Pachymetry L27373 A47396 Debridement Services L25820 A44930 Drugs and Biologicals, Coverage of, for Label and Off-Label Uses L32963 N/A EEG 24 Hour Monitoring L33371 N/A Endoscopic Treatment of GERD L25211 A44399 Erythropoiesis Stimulating Agents (ESA) L32977 N/A Galectin-3 L33384 N/A Heavy Metal Testing L25678 A45194 Hospice - Determining Terminal Status L32454 A51615 Implantable Miniature Telescope (IMT) L28490 A48000 Incision and Drainage (I & D) of Abscess of Skin, Subcutaneous and Accessory Structures L25367 N/A Magnetic Resonance Angiography (MRA) National Government Services, Inc. Page 4 of 8
L33385 N/A Nerve Blocks for Peripheral Neuropathy L33386 N/A Nerve Conduction Studies and Electromyography L32456 N/A Non-covered Services L27355 A47394 Non-Invasive Vascular Studies L28178 A48353 Nonvascular Extremity Ultrasound L26441 A45936 Ophthalmic Biometry for Intraocular Lens Power Calculation L25466 A44439 Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography) L32945 N/A Osteopathic Manipulative Treatment L26884 A50612 Outpatient Physical and Occupational Therapy Services L28529 A48042 Pain Management L28497 A48012 Panretinal (Scatter) Laser Photocoagulation L28395 N/A Percutaneous Coronary Intervention L31391 A50267 Posterior Tibial Nerve Stimulation for Voiding Dysfunction L33387 N/A Proton Beam Therapy L25507 A44896 Psychiatric Inpatient Hospitalization National Government Services, Inc. Page 5 of 8
L26398 A45932 Psychiatric Partial Hospitalization Programs L26895 N/A Psychiatry and Psychology Services L28145 A48395 Qualitative Drug Screening L33388 N/A Radiofrequency Treatment for Urinary Incontinence L28463 N/A RAST Type Tests L27362 A47397 Removal of Benign Skin Lesions L26426 A45934 Routine Foot Care and Debridement of Nails L28488 A48003 Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI) L27404 A47407 Speech-Language Pathology L33390 N/A Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT) L32038 A50991 Transcranial Magnetic Stimulation L27381 A48398 Transesophageal Echocardiography (TEE) L26876 A46192 Transrectal Ultrasound L27360 A48398 Transthoracic Echocardiography (TTE) L25519 A44614 Varicose Veins of the Lower Extremity, Treatment of L26851 N/A Urodynamics L33389 N/A Venous Angioplasty with or without Stent Placement for the Treatment of Chronic Cerebrospinal Venous Insufficiency National Government Services, Inc. Page 6 of 8
L26439 A45937 Vertebroplasty and Vertebral Augmentation (Percutaneous) L26367 A45897 Visual Fields Testing L29510 A49254 Vitamin D Assay Testing Medical Policy Articles not associated with an LCD: Article ID A48361 A51525 A51974 A49286 A48292 A50548 Article Title Arthroscopic Lavage and Arthroscopic Debridement for the Osteoarthritic Knee Medical Policy Article Blepharoplasty - Medical Policy Article Bone Mass Measurement - Medical Policy Article Clinical Trials Medical Policy Article Collagen Implantation for Urinary Incontinence - Medical Policy Article Colorectal Cancer Screening Medical Policy Article A51614 Coverage and Billing FDG Positron Emission Tomography (PET) Scans - Medical Policy Article A49058 CPT Code 87641 (Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, methicillin resistant, amplified probe technique) - Medical Policy Article A51630 Dialysis Access Maintenance - Medical Policy Article A48209 Health and Behavior Assessment/Intervention Medical Policy Article A52174 Hyperbaric Oxygen (HBO) Therapy - Medical Policy Article A48210 Initial Hospital Care Visits Medical Policy Article A45910 Investigational Device Exemption Requests Medical Policy Article A51967 Laparoscopic Sleeve Gastrectomy (LSG) Medical Policy Article A47355 Local Coverage Determination (LCD) Reconsideration Process - Medical Policy Article Medical Nutrition Therapy (MNT) Services - Medical Policy Article A46071 A51667 Ocular Blood Flow Tests Medical Policy Article National Government Services, Inc. Page 7 of 8
A52210 A47521 A51723 A2311 A50641 A51834 A51789 A49710 A49273 Polysomnography and Sleep Studies Medical Policy Article Process for Determining Self-Administered Drug Exclusions Medical Policy Article Psychological Services Coverage under the Incident to Provision for Physicians and Non-physicians Medical Policy Article Self-Administered Drug Exclusion List - Medical Policy Article (R25) Skilled Nursing Facilities (Including Swing Beds) Medical Policy Article Stem Cell Transplantation Medical Policy Article Surveillance of Implantable or Wearable Cardioverter Defibrillators (ICDs): Office, Hospital, Web, or Non-Web Based Medical Policy Article Tetanus Immunization - Medical Policy Article Vagus Nerve Stimulation Medical Policy Article National Government Services, Inc. Page 8 of 8