MACs Update LCDs for 2012

Medicare administrative contractors (MACs) are fervently updating their local coverage determinations (LCDs) to coincide with 2012 coding changes brought forth by the American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS).

Highmark Medicare Services, for example, has revised the following LCDs to reflect the annual CPT® and HCPCS Level II code updates, effective for services performed on or after Jan. 1, 2012:

Electromyography (EMG) and Nerve Conduction Studies (L29547)

Highmark has added the following CPT® codes to the EMG list:

+95885 Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; limited (List separately in addition to code for primary procedure)

+95886 Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; complete, 5 or more muscles studied, innervated by 3 or more nerves or 4 or more spinal levels (List separately in addition to code for primary procedure)

+95887 Needle electromyography, non-extremity (cranial nerve supplied or axial) muscle(s) done with nerve conduction, amplitude and latency/velocity study (List separately in addition to code for primary procedure)

Human Skin Equivalents (HSE) – Use in the Treatment of Chronic Cutaneous Ulcer Wounds (L27549)

To this LCD, Highmark has added the following CPT® codes:

15271 Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area

+15272 Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure)

15275 Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area

+15276 Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure)

Highmark has deleted the following:

G0440 Application of tissue cultured allogeneic skin substitute or dermal substitute; for use on lower limb, includes the site preparation and debridement if performed; first 25 sq cm or less

G0441 Application of tissue cultured allogeneic skin substitute or dermal substitute; for use on lower limb, includes the site preparation and debridement if performed; each additional 25 sq cm

Skin repair codes 15340, 15365, and 15366 are also deleted for 2012.

Injectible Collagenase Clostridum Histolyticum for Dupuytren’s Contracture (L31171)

To this LCD, Highmark has added:

20527 Injection, enzyme (eg, collagenase), palmar fascial cord (ie, dupuytren’s contracture)

26341 Manipulation, palmar fascial cord (ie, dupuytren’s cord), post enzyme injection (eg, collagenase), single cord

Report procedure code 20527 for the administration of collagenase clostridium histolyticum for Dupuytren’s contracture. Redirection of a needle in the subcutaneous or intralesional tissue is not reported as a separate injection. Use of digit modifiers and RT or LT may be appended to 20527 to identify the injected digit. A separately identifiable evaluation and management (E/M) service performed on the same day as a Dupuytren’s contracture injection must be reported with modifier 25.

Deleted from this LCD are codes:

20550 Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar “fascia”)

97140 Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes

Non-invasive Cerebrovascular Arterial Studies (L27504)

Highmark has deleted CPT® code 93875 Noninvasive physiologic studies of extracranial arteries, complete bilateral study (eg, periorbital flow direction with arterial compression, ocular pneumoplethysmography, Doppler ultrasound spectral analysis) from this LCD.

Serotypes A and B Botulinum Toxin Products (L27476)

Highmark has added J0588 Injection, incobotulinumtoxin a, 1 unit to this LCD and deleted Q2040 Injection, incobotulinumtoxin a, 1 unit.

Speech-language Pathology (SLP) Services: Communication Disorders (L27531)

To this LCD, Highmark has revised:

96110 Developmental screening, with interpretation and report, per standardized instrument form

96111 Developmental testing, (includes assessment of motor, language, social, adaptive, and/or cognitive functioning by standardized developmental instruments) with interpretation and report

Procedure code 96110 is now a screening service and non-covered, effective for dates of service on or after Jan. 1, 2011. A code similar to the previous 96110 descriptor now appears in the HCPCS Level II coding system as G0451 Developmental testing, with interpretation and report, per standardized instrument form, and is covered by Medicare, according to the American Speech-Language-Hearing Association (ASHA).

CPT® code 96111 was revised to remove the word “extended” from the descriptor. This code includes assessment of motor, language, social, adaptive, and/or cognitive functioning by standardized developmental instruments; with interpretation and report.

Transforaminal Epidural, Paravertebral Facet, and Sacroiliac Joint Injections (L27512)

The procedure code 27096 Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or ct) including arthrography when performed has been added to the code listing on the LCD and the description has been revised per the annual update to include fluoroscopy or CT image guidance.

Code 73542 has been deleted; and the descriptor for 77003 Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural, subarachnoid) has been changed for 2012.

Radiation Therapy Services (L27515)

Most recently, Highmark finalized this LCD to reflect the annual CPT®/HCPCS Level II update, effective Jan. 1, 2012. The update deletes the following CPT® codes:

77424 Intraoperative radiation treatment delivery, X-ray, single treatment session

77425 Intraoperative radiation treatment delivery, electrons, single treatment session

These new codes were created to describe intra-operative radiation treatment (IORT) delivery in a single treatment session differentiated by the type of radiation source, i.e., X-ray (77424) vs. electrons (77425), as the times for treatment delivery, staffing requirements, and machine capital requirements are vastly different for IORT treatments compared to conventional treatment described by existing codes, according to the American College of Radiology (ACR). These codes are technical-only codes and are typically reported in the facility setting.

Check the Medicare Coverage Database website for recent LCD changes made by your MAC.

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