Cahaba LCD Updates November 2009

Cahaba GBA has updated two Local Coverage Determinations (LCDs) effective for dates of service on and after November 1, 2009.

Medicine: Partial Hospitalization Programs (L30008)
The following diagnosis codes for certain schizophrenic disorders were added to the list of ‘ICD-9 Codes that Support Medical Necessity’ for the LCD on Partial Hospitalization Programs.

• 295.11 - 295.14 disorganized type
• 295.21 - 295.24 catatonic type
• 295.31 - 295.34 paranoid type
• 295.41 - 295.44 schizophreniform disorder
• 295.71 - 295.74 schizoaffective disorder
• 295.91 - 295.94 unspecified schizophrenia
  (all specified as subchronic, chronic, subchronic with acute exacerbation, or chronic with acute exacerbation)

Medicine: Wireless Capsule Imaging (L30011)
This LCD was liberalized with a revision to the language contained in the ‘Limitations’ and ‘Utilization Guidelines’ sections.  The statement “Greater than one test per year will be denied as not medically necessary in the absence of supportive documentation.” was removed from these sections.  The statement “It is expected that this test will be performed only once during any episode of illness” remains in these sections of the policy.

The complete LCDs can be viewed at this website: Cahaba GBA LCDs