Cahaba GBA Local Coverage Determinations (LCD) Updates for January 2010

on Thursday, 07 January 2010. All News Items

Effective January 1, 2010, the following Local Coverage Determinations (LCDs) have been revised as stated.

Medicine: Debridement Services (L30004)
The following diagnosis code is being added to the list of ‘ICD-9 Codes that Support Medical Necessity’:
• 459.33 (Chronic venous hypertension with ulcer and inflammation)

Medicine: Physical Therapy - Outpatient (L30009)
CPT code 95992 (Canalith repositioning procedure(s)) has been removed from the 2010 Therapy Code List; therefore, the procedure is removed from this LCD.

When medically necessary, time spent performing these procedures is covered as either CPT 97110 or 97112, depending on the specific services rendered. Please review the Vestibular Rehabilitation Section of the LCD for details regarding coverage.

Local Coverage Determination (LCD) Updates - 2010 CPT/HCPCS Codes
The following LCDs were revised as a result of the annual updates to CPT and HCPCS codes.  These CPT/HCPCS code revisions do not make any changes to the coverage requirements of the existing policies.
Drugs and Biologicals: Bevacizumab (AVASTIN TM) (L29992)

  • Q2024 is invalid effective December 31, 2009 and is replaced with C9257 (bevacizumab injection 0.25 mg). In addition, J3590 (Unclassified biologics) should not be used to bill for the ophthalmic indications listed in the LCD.

Pathology and Laboratory: Syphilis Testing (L30013)

  • 86781 is invalid effective December 31, 2009 and is replaced with 86780 (treponema pallidum).

Radiology: Computed Tomographic Angiography of the Heart and Coronary Vessels (L30014)

  • 0144T is invalid effective December 31, 2009 and is replaced with 75571.
    Note: This procedure is non-covered.
  • 0145T, 0146T, 0147T, 0148T, 0149T, 0150T and 0151T are invalid effective December 31, 2009 and are replaced with 75572, 75573 and 75574.

Drugs and Biologicals: Zoledronic Acid (L30003)
The indications for Reclast® are being clarified. Reclast® is indicated for Postmenopausal Osteoporosis in Women and Osteoporosis in Men. The Indications section of the LCD will be updated; however, the list of ICD-9 Codes that Support Medical Necessity will not change since ICD-9 code 733.01 for Senile Osteoporosis is not gender specific.

Off-Label Use Statement Added to Four Drug LCDs
The statement “For off-label use, please refer to the Medicare Benefit Policy Manual, Chapter 15, Section 50.4.5.” has been added to the ‘Limitations’ sections of the following LCDs.

  • Drugs and Biologicals: Bevacizumab (AVASTIN ®) (L29992)
  • Drugs and Biologicals: Gemcitabine Hydrochloride (Gemzar ®) (L29995)
  • Drugs and Biologicals: Oxaliplatin (Eloxatin®) (L29999)
  • Drugs and Biologicals: Rituximab (Rituxan ®) (L30002)

Updates to the Cahaba LCDs are published on the What's New Page of the Cahaba GBA website.  All LCDs and articles can be accessed from the Cahaba GBA website at Local Coverage Determinations (LCDs) and Articles (choose your state and select ‘LCDs’).

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