Medicare Coverage Updates June 2010

on Tuesday, 22 June 2010. All News Items

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

Medicine: Speech Language Pathology - Outpatient (L30010)
The following ICD-9 diagnosis codes were added to the list of ‘ICD-9 Codes that Support Medical Necessity’:

  • 905.0 Late effect of fracture of skull and face bones
  • 907.0 Late effect of intracranial injury without mention of skull fracture

Drugs and Biologicals: Oxaliplatin (Eloxatin®) (L29999)

  • Coverage is expanded to the off-label uses for Gallbladder cancer and Extrahepatic cholangiocarcinoma.
  • The following ICD-9 diagnosis codes were added to the list of “ICD-9 Codes that Support Medical Necessity”: 156.0-156.2, 156.8 and 156.9
  • This LCD has been updated to more clearly delineate between the FDA indications and the Off-label uses.

Draft LCDs Finalized
The following Draft LCDs have been finalized. The Notice period will begin June 17, 2010. The LCDs will become effective August 1, 2010.

  • Pathology and Laboratory: Vitamin D Assay Testing (DL30905)
  • Radiology: Computed Tomographic (CT) Colonography (DL30896)

Providers can read a summary of comments submitted during the Comment period and Cahaba’s responses by opening the ‘Comment and Response’ document located at the end of each LCD under the Articles field.
NOTE: The Draft LCD Radiology: Magnetic Resonance Angiography of the Head and Neck (DL30909) has been rescinded.

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).

Lab National Coverage Determinations (NCD) Updates
 CMS Transmittal 1963 (CR 6964) updates the Laboratory National Coverage Determinations to reflect coding updates for this quarter. The updates will be effective July 1, 2010.  ICD-9-CM codes V17.4 and V18.1 are deleted and replaced with the following expanded 5 digit codes on the list of non-covered ICD-9-CM codes for all 23 lab NCDs.

  • V17.41  Family history of sudden cardiac death (SCD)
  • V17.49  Family history of other cardiovascular diseases
  • V18.11  Family history of multiple endocrine neoplasia (MEN) syndrome
  • V18.19  Family history of other endocrine and metabolic diseases


Medicare NCD Updates

Dermal Injections for Treatment of Facial Lipodystrophy Syndrome (LDS)

Effective for claims with dates of service on and after March 23, 2010, dermal injections for facial LDS are only reasonable and necessary using dermal fillers approved by the Food and Drug Administration for this purpose, and then only in HIV-infected beneficiaries who manifest depression secondary to the physical stigma of HIV treatment. See CMS Transmittal 122 (CR6953).
OPPS hospitals should bill for this service uses HCPCS code C9800.  For more information on billing, see CMS Transmittal 1978 (CR6953) or the July 2010 OPPS update transmittal CMS Transmittal 1980 (CR6996).

Collagen Meniscus Implant

Effective for services performed on or after May 25, 2010, CMS has concluded that the evidence demonstrates that the collagen meniscus implant does not improve health outcomes. Thus, CMS has determined that the collagen meniscus implant is not reasonable and necessary and is non-covered as identified in Pub. 100-03, NCD Manual, section 150.12.  A new HCPCS code G0428: Collagen or other tissue engineered meniscus knee implant procedure for filling meniscal defects (e.g., collagen scaffold, Menaflex) will be available for use in non-covering collagen meniscus implant claims with dates of service on and after May 25, 2010.  See CMS Transmittal 121 (CR6903) or CMS Transmittal 1977 (CR6903) for more information.

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