Jurisdiction 9 MAC Posts New LCDs

Florida, Puerto Rico, and U.S. Virgin Islands providers submitting claims to Part B Medicare Administrative Contractor (MAC) First Coast Service Options (FCSO) should become familiar with a number of Local Coverage Determinations (LCDs) in the works.

Ultrasound of the Spine (L30353)

This LCD provides coverage information and coding guidelines for ultrasound of the spine. This service is considered medically reasonable and necessary when used intra-operatively for adults; and in the diagnostic evaluation of the spinal cord and canal of newborns and infants, ranging in age from birth to 24 months.

Ultrasound imaging is a noninvasive diagnostic imaging modality that includes exposing part of the body to high-frequency ultrasound waves to produce both imaging and Doppler examinations. Images are captured in real-time and can illustrate the structure and movement of the internal organs of the body, and blood flowing through blood vessels.

This new LCD is effective for services rendered on or after Sept. 30.

Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy (L30366)

This LCD indicates when FCSO Medicare will consider stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) medically reasonable and necessary, as well as coding guidelines.

SRS and SBRT are noninvasive means of administering high-dose radiotherapy to discreet tumor foci in cranial or extracranial locations respectively. The two forms of treatment share certain overarching principles, namely the use of image guidance and related treatment delivery technology for escalating the radiation dose to the tumor with as little radiation dose to the surrounding tissue as possible. Both methods are achieved with a “sterotactic” technique.

This new LCD is effective for services rendered on or after Oct. 5.

Pharmacologic Medication Management for Psychiatry Services (L30351)

This LCD includes coverage indications and limitations, ICD-9-CM codes, and documentation requirements for pharmacologic medication management for psychiatry services.

CPT® code 90862 Pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy represents pharmacologic medication management, and is should be used by physicians or master’s prepared psychiatric nurses with state authorized prescribing privileges who are prescribing pharmacological therapy for patients with psychiatric disorders. This CPT® code should only be reported when the qualified clinician is providing in-depth evaluation and monitoring of psychopharmacologic medication and is personally coordinating medication decisions with the patient in a face-to-face encounter.

HCPCS Level II code M0064 Brief office visit for the sole purpose of monitoring or changing drug prescriptions used in the treatment of mental psychoneurotic and personality disorders involves monitoring or changing psychopharmacologic medication, and is intended for use by the physician, physician’s assistant, or advanced registered nurse with psychiatric training and acting within the scope of practice.

This new LCD is effective for services rendered on or after Sept. 30.

Revised LCDs

Also of note, FCSO has revised the following LCDs:

NCSVCS: The list of Medicare noncovered services (L29288, Florida) (L29398, Puerto Rico/U.S. Virgin Islands)

THERSVCS: Therapy and rehabilitation services (L29289, Florida) (L29399, Puerto Rico/U.S. Virgin Islands)

Debridement Services (L29128, Florida) (L29146, Puerto Rico/U.S. Virgin Islands)

Percutaneous lysis of epidural adhesions (L29256, Florida) (L29465, Puerto Rico/U.S. Virgin Islands)

Destruction of paravertebral facet joint nerve(s) (L29132, Florida) (L29150, Puerto Rico/U.S. Virgin Islands)

Intensity modulated radiation therapy (IMRT) (L29200, Florida) (L29352, Puerto Rico/U.S. Virgin Islands)

You can review these LCDs through the Centers for Medicare & Medicaid Services’ (CMS) Medicare Coverage Database.

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