Medicare Coverage Updates July 2010

on Thursday, 15 July 2010. All News Items

Cahaba GBA Coverage Updates

Effective July 1, 2010 Cahaba GBA updated the following Local Coverage Determinations (LCDs):

Radiology: Computed Tomography of the Head or Brain (L30016)
Coverage was expanded to include Electroconvulsive Therapy (ECT) treatment planning.)
The following ICD-9 diagnosis codes were added to the list of ‘ICD-9 Codes that Support Medical Necessity’:

  • V07.8 Other specified prophylactic measure (use for ECT treatment planning)
  • 920 Contusion of face, scalp, and neck except eye(s)

Radiology: Magnetic Resonance Imaging of the Brain (L30018)
The following ICD-9 diagnosis code was added to the list of ‘ICD-9 Codes that Support Medical Necessity’:

  • 793.0 Nonspecific (abnormal) findings on radiological and other examination of head and skull

Draft LCDs in Comment Period
The following three Draft LCDs have been released for comment. The Comment period is July 9, 2010 through August 23, 2010.

  • Pathology and Laboratory: Syphilis Testing (DL30013)
  • Radiology: Ultrasound Guidance for Vascular Access Requiring Ultrasound Evaluation of Potential Access Sites (DL31295)
  • Medicine: Health and Behavior Assessment/Intervention (DL31300)

Cahaba GBA’s LCDs can be accessed from their web site at Local Coverage Determinations (LCDs) and Articles (choose your state and select “LCDs” for active LCDs; select ‘Display Draft Documents’ to view draft LCDs).

Medicare NCD Updates

Magnetic Resonance Angiography (MRA)
CMS has combined the coverage requirements of MRA into the MRI National Coverage Determination (NCD).  This information was released in two CMS Transmittals: R1998CP and R123NCD 

Since MRA is a specific application of MRI, CMS believes that the continued existence of separate NCDs is unnecessary.  The provisions of the MRA NCD at Pub. 100-03, NCD Manual, section 220.3 are being merged under the NCD for MRI at Pub. 100-03, NCD Manual, section 220.2. Thus, section 220.3, MRA, of the NCD Manual, will no longer appear as a separate NCD.

The effect of this change will maintain existing national coverage for both MRI and MRA, and will eliminate the non-coverage language that currently exists for MRA at Pub. 100-03, NCD Manual, section 220.3, thereby permitting local Medicare contractors to cover (or not cover) all indications of MRA (and MRI) that are not specifically nationally covered or nationally non-covered.


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