Cahaba LCD Updates for February and March 2010

on Thursday, 04 March 2010. All News Items

Cahaba GBA has recently published the following updates to their Local Coverage Determinations.   Updates to LCDs are available on the Cahaba website Part A What's New.

Medicine: Inpatient Rehabilitation (L30006) - Retired
The Inpatient Rehabilitation LCD was retired effective January 1, 2010 due to changes in the national coverage guidelines for Inpatient Rehabilitation facilities.  The current IRF guidelines can be found in the CMS Internet Only Manual located at , Section 110.

Drugs and Biologicals: Oxaliplatin (Eloxatin®) (L29999)
Coverage of Non-Hodgkin’s Lymphoma was added as an off-label use to the LCD for Oxaliplatin effective February 1, 2010.
The following diagnosis codes have been added to the list of ‘ICD-9 Codes that Support Medical Necessity’:

  • 200.40 - 200.48 Mantle cell lymphoma
  • 200.50 - 200.58 Primary central nervous system lymphoma
  • 200.60 - 200.68 Anaplastic large cell lymphoma
  • 200.80 - 200.88 Lymphoma – other named variants

Drugs and Biologicals: Gemcitabine Hydrochloride (Gemzar ®) (L29995)
Effective March 1, 2010
, Fallopian Tube Cancer and Primary Peritoneal Cancer will be covered for off-label use for the drug Gemzar.  The LCD was also revised to delineate between FDA indications and off-label uses.
The following diagnosis codes are being added to the list of ‘ICD-9 Codes that Support Medical Necessity’:

  • 183.2  Malignant neoplasm of fallopian tube
  • 183.3  Malignant neoplasm of broad ligament
  • 183.4  Malignant neoplasm of parametrium
  • 183.5  Malignant neoplasm of round ligament
  • 183.8  Malignant neoplasm of other specified sites of uterine adnexa
  • 183.9  Malignant neoplasm of uterine adnexa, unspecified
  • V10.43  Personal history of malignant neoplasm, ovary

Guidelines in Therapy Policies Updated
Cahaba updated the guidelines in several sections of the therapy policies for Outpatient Physical Therapy, Outpatient Occupational Therapy, Speech Language Pathology, and Dysphagia/ Swallowing Therapy. 

Drugs and Biologicals: Bevacizumab (AVASTIN®) (L29992)
Coverage of Bevacizumab (Avastin®) for ophthalmic conditions has been removed from this LCD and is included in the LCD Drugs and Biologicals: Antiangiogenic Therapy for Ophthalmic Conditions (L30555).  The LCD was also updated to delineate between the FDA indications and the off-label uses.

Finalized Draft Local Coverage Determinations (LCDs)
The LCDs listed below became effective March 1, 2010.

  • Drugs and Biologicals: Antiangiogenic Therapy for Ophthalmic Conditions (DL30555)
  • Pathology and Laboratory: C-Reactive Protein; High Sensitivity (hs-CRP) (DL30591)
  • Surgery: YAG Capsulotomy (DL30068)

Note that the original draft policy on C-Reactive Protein; High Sensitivity included restrictions on the billing of C-Reactive Protein and Erythrocyte Sedimentation Rate (ESR) on the same date of service.  All requirements for CRP and ESR were removed from the policy in its final form.  The effective policy only addresses the non-coverage of hsCRP.

All Part A Cahaba LCDs can be accessed from their web site at Local Coverage Determinations (LCDs) and Articles (choose your state and select ‘LCDs’).

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