Medicare Coverage Updates March 2011

on Tuesday, 22 March 2011. All News Items

National Coverage Determinations Policies

Effective for claims with dates of service on or after February 24, 2011, CMS will allow for coverage of MRI for Medicare beneficiaries with implanted pacemakers (PMs) or implantable cardioverter defibrillators (ICDs) when those beneficiaries are enrolled in clinical studies that are approved by CMS for the purpose of gaining further evidence about the utility and safety of MRI exposure. Patients in clinical studies must meet the coverage criteria at section 220.2.C.1 of the NCD Manual. For details see, Transmittal 2171 and Transmittal 132 or MLN Matters Article MM7296.

The April 2011 quarterly updates to the Laboratory NCDs made changes to the ICD-9-CM codes that do not support medical necessity for Blood Counts. For details see MLN Matters Article MM7290.

Cahaba GBA Local Coverage Determination Policies and Articles

Changes were recently made to the following Cahaba GBA local coverage policies:

Diagnosis Code Additions

LCD - Radiology: Computed Tomography of the Thorax (L30050)

LCD - Drugs and Biologicals: Zoledronic Acid (L30035)  

LCD - Radiology: Computed Tomography of the Abdomen and Pelvis (Note: the link to this article on the Cahaba website is currently incorrect; check for an updated link)

New Policies

Final Draft LCDs effective April 1, 2011 for:

  • Drugs and Biologicals: Botulinum Toxins (DL30025),
  • Bioengineered Skin Substitutes (BSS) (DL31428), and
  • Surgery: Vertebral Augmentation Procedures (VAPs) (DL30062)

Educational Article: Gastric Restrictive Procedures and Subsequent Visits (A50678)

All Cahaba LCDs and articles can be accessed from the Cahaba GBA ( web site at Local Coverage Determinations (LCDs) and Articles  (choose your state and select ‘LCDs’ or ‘Articles’).

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