Medicare Coverage Updates October 2010

on Friday, 15 October 2010. All News Items

Recent National Coverage Determination updates include a change in the number of PET scans covered for therapeutic purposes in the initial treatment strategy for suspected solid tumors and myeloma.  Effective August 4, 2010, Medicare will continue to nationally cover one FDG PET scan for these indications; and Local Medicare Contractors will have discretion to cover (or not cover), within their jurisdictions, any additional FDG PET scans for therapeutic purposes related to the initial treatment strategy.  See MLN Matters Article MM7148 for more information.

Tobacco Cessation Coverage Update
CMS also expanded the coverage for tobacco cessation counseling effective for claims with date of service on and after August 25, 2010, to include outpatient and hospitalized Medicare beneficiaries:

  1. Who use tobacco, regardless of whether they have signs or symptoms of tobacco-related disease;
  2. Who are competent and alert at the time that counseling is provided; and
  3. Whose counseling is furnished by a qualified physician or other Medicare-recognized practitioner. 

Previously, cessation counseling was limited to individuals who use tobacco and have been diagnosed with a recognized tobacco-related disease or who exhibit symptoms consistent with tobacco-related disease.

OPPS hospitals should continue to use CPT codes 99406 and 99407 for symptomatic individuals.  The following C codes are to be used for services for asymptomatic individuals from August 25, 2010 through December 31, 2010.

  • C9801: Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes
  • C9802: Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes

Effective January 1, 2010, the following new G codes should be used to bill for treatment of asymptomatic patients.

  • G0436: Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes
  • G0437: Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes

The diagnosis codes that should be reported for these individuals are ICD-9 codes 305.1, non-dependent tobacco use disorder, or V15.82, history of tobacco use.  CMS will allow two individual tobacco cessation counseling attempts per year. Each attempt may include a maximum of four intermediate OR intensive sessions, with a total benefit covering up to 8 sessions per year per Medicare beneficiary who uses tobacco. The practitioner and patient have the flexibility to choose between intermediate (more than 3 minutes but less than 10 minutes), or intensive (more than 10 minutes) cessation counseling sessions for each attempt.  Section 4104 of the Affordable Care Act provided for a waiver of the Medicare coinsurance and Part B deductible requirements for this service effective on or after January 1, 2011. Until that time, this service will be subject to the standard Medicare coinsurance and Part B deductible requirements.

For more information on tobacco cessation counseling, see Transmittal 2058 and Transmittal 126

There are extensive LCD and NCD updates this month because the new ICD-9-CM code changes became effective October 1, 2010.  Coverage policies such as LCDs, Articles and Laboratory NCDs that detail ICD-9-CM codes for coverage or non-coverage must be revised to reflect the ICD-9-CM updates.  Also Cahaba GBA updated two LCDs and one article: diagnosis 794.39, Other nonspecific abnormal function study of cardiovascular system was added as a covered diagnosis to the CTA of the Heart and Coronary Vessels LCD; diagnoses V58.65, long-term (current) use of steroids, and V58.69, long-term (current) use of other medications were added as covered diagnoses to the Bone Mass Measurement article; and the Limitations section of the Physical Therapy policy was liberalized for CPT codes 97001 and 97002.  Details of all these changes can be viewed at this pdf file: October 2010 Medicare Coverage Updates - Details.

All Cahaba LCDs and Articles can be found on the Cahaba website at the following link: http://www.cahabagba.com/part_a/policies_medical_review/lcd_active.htm

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