Medicare Coverage Updates September 2010

on Wednesday, 08 September 2010. All News Items

CMS recently announced an expansion of tobacco cessation counseling for Medicare beneficiaries.  Prior to the new coverage rules, only individuals with tobacco-related diseases were eligible for the counseling.  Under the new rules, all Medicare smokers are eligible to receive two individual tobacco cessation counseling attempts per year.  Each attempt may include up to four sessions for a total annual benefit of eight sessions.  Intermediate and intensive smoking cessation counseling services will be covered for outpatient and hospitalized beneficiaries who are smokers, as long as those services are furnished by qualified physicians and other Medicare-recognized practitioners.  Under the Affordable Care Act, effective Jan. 1, 2011, Medicare will cover preventive care services such as the tobacco cessation counseling services at no cost to beneficiaries.  View the Decision Memo for complete information.

Cahaba GBA announced the consolidation of duplicate Part A and Part B LCDs into single documents effective September 1, 2010.  Since the LCDs are identical, the consolidation does not alter the content or coverage, but only changes the policy number.  See the Cahaba Announcement for a list of the combined policies.

Cahaba GBA added three new articles to CMS Medicare Coverage Database for Pulmonary Rehabilitation, Cardiac Rehab and Intensive Cardiac Rehab, and Insertion of Posterior Spinous Process Distraction Device.  The articles detail the covered ICD-9-CM diagnosis codes that support medical necessity for these services.  Cahaba also updated several existing LCDs and a coverage article.  See the tables below for details and links.

Policy Description: Gemcitabine Hydrochloride (Gemzar ®)
Policy Number: L29995
Policy Type: Cahaba LCD
Type of Change: Updated
Effective Date: 9/1/2010
New Codes that Support
Medical Necessity:
164.0  Malignant neoplasm of thymus
Other Changes / Comments:
Policy Link: Gemzar LCD

  

Policy Description: CPT 0171T and 0172T (Insertion of posterior spinous process distraction device)
Policy Number: A50029
Policy Type: Cahaba Educational Article
Type of Change: New
Effective Date: 8/28/2009
New Codes that Support
Medical Necessity:
724.02 (spinal stenosis, lumbar regionand 349.9 (unspecified disorders of the nervous system - use this code for neurogenic intermittent claudication)
Other Changes / Comments: Must use both codes
Policy Link: CPT 0171T and 0172T Article

 

Policy Description: Hyperbaric Oxygen Therapy (HBO)
Policy Number: A48900
Policy Type: Cahaba Article - NCD
Type of Change: Updated
Effective Date: 9/1/2010
New Codes that Support
Medical Necessity:
909.2 (Late effect of radiation)
Other Changes / Comments:
Policy Link: HBO Article

 

Policy Description: Pathology and Laboratory: Vitamin D Assay Testing
Policy Number: L30905
Policy Type: Cahaba LCD
Type of Change: Updated
Effective Date: 9/1/2010
New Codes that Support
Medical Necessity:
263.0 (malnutrition of moderate degree)
Other Changes / Comments: For 25 OH vitamin D (CPT 82306) only
Policy Link: Vitamin D Testing LCD

 

Policy Description: Pulmonary Rehabilitation (PR) Services
Policy Number: A50031
Policy Type: Cahaba Educational Article
Type of Change: New
Effective Date: 1/1/2010
New Codes that Support
Medical Necessity:
See article
Other Changes / Comments:
Policy Link: PR Article

 

Policy Description: Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Services
Policy Number: A50030
Policy Type: Cahaba Educational Article
Type of Change: New
Effective Date: 1/1/2010
New Codes that Support
Medical Necessity:
See article
Other Changes / Comments:
Policy Link: CR/ICR Article

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

green-iconWe are an environmentally conscious company, dedicated to living “green” both at work and as individuals.

Location

home-icon
1900 Twentieth Avenue South
Suite 220
Birmingham, AL 35209

Connect

phone
205-941-1105
phone
800-592-9639
email
This email address is being protected from spambots. You need JavaScript enabled to view it.

 

 mhms