Annual Checkup: Medicare Policies for Code Updates

Annual Checkup: Medicare Policies for Code Updates

The Centers for Medicare & Medicaid Services (CMS) released, Feb. 1, maintenance updates for several National Coverage Determinations (NCDs) to reflect recent code changes (CR11134).

Every year, when ICD-10, CPT®, and HCPCS Level II codes are updated, NCDs (and Local Coverage Determinations) must also be updated. When this occurs, it’s essential for providers to review these policies to see how the code changes will affect coverage for services they provide to their patients.

Here’s a quick look at the latest NCD updates:

NCD 20.29 – Hyperbaric Oxygen Therapy (HBO)

Corrected description for ICD-10-CM code L59.8 Other specified disorders of the skin and subcutaneous tissue related to radiation.

NCD 110.18 – Aprepitant for Chemotherapy-Induced Emesis

Added J9153 Injection, levetiracetam, 10 mg to the list of chemotherapeutic drugs associated with this policy, effective Jan. 1, 2019.

NCD 110.23 – Stem Cell Transplantation (SCT)

Added D47.1 Chronic myeloproliferative disease for covered allogeneic SCT in clinical trial for myelofibrosis, effective July 1, 2019, for Medicare Part B.

NCD 160.18 – Vagus Nerve Stimulation (VNS)

Added 95976 Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with simple cranial nerve neurostimulator pulse generator/transmitter programming by physician or other qualified health care professional and 95977 Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with complex cranial nerve neurostimulator pulse generator/transmitter programming by physician or other qualified health care professional to Proposed HCPCS/CPT Part A and Part B column.

NCD 160.24 – Deep Brain Stimulation (DBS) for Essential Tremor and Parkinson’s Disease

Deleted CPT® codes 95978 and 95979, effective Dec. 31, 2018.

Added CPT® codes 95983 Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with brain neurostimulator pulse generator/transmitter programming, first 15 minutes face-to-face time with physician or other qualified health care professional and 95984 Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with brain neurostimulator pulse generator/transmitter programming, each additional 15 minutes face-to-face time with physician or other qualified health care professional (List separately in addition to code for primary procedure), effective Jan. 1, 2019.

NCD 110.21 – Erythropoiesis Stimulating Agents (ESAs) in Cancer and Related Neoplastic Conditions

Effective July 1, 2018, CMS added Q5106 Injection, epoetin alfa, biosimilar, (Retacrit) (for non-ESRD use), 1,000 units to the list of codes:

  • Part A MACs and FISS shall deny Q5106 billed with modifier EC ESA, anemia, non-chemo/radio when any one of the specified noncovered diagnosis codes is present on the claim.
  • FISS shall deny Q5106 when billed with modifier EB ESA, anemia, radio-induced, regardless of diagnosis, no discretion.
  • Part A MACs shall deny Q5106 when billed with modifier EA ESA, anemia, chemo-induced for anemia secondary to myelosuppressive anticancer chemotherapy in solid tumors, multiple myeloma, lymphoma, and lymphocytic leukemia when a hemoglobin 10.0g/dL or greater or hematocrit 30.0% or greater is reported.
  • Part A MACs have discretion to cover or noncover non-ESRD ESA services for any other non-radio/non-chemo-induced anemias with modifier EC or non-chemo-induced anemias with modifier EA that are not specifically addressed in the NCD.
  • Part B MACs/MCS shall deny Q5106 billed with modifier EC when any one of the specified noncovered diagnosis codes (in the NCD) is present on the claim.
  • MCS shall deny Q5016 billed with modifier EB, regardless of diagnosis, no discretion.
  • Part B MACs have no discretion to cover or noncover Q5106 billed with modifier EC or EA.

NCD 150.3 – Bone Mineral Density Studies

code-books-shipping

Added CPT® Category III code 0508T Pulse-echo ultrasound bone density measurement resulting in indicator of axial bone mineral density, tibia to list of codes Medicare Part A/B will pay when a claim contains a valid diagnosis code (i.e., listed in the NCD), effective July 1, 2018.

Renee Dustman
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Renee Dustman

Executive Editor at AAPC
Renee Dustman, BS, AAPC MACRA Proficient, is an executive editor at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 20 years experience in print production and content management. Follow her on Twitter @dustman_aapc.
Renee Dustman
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About Has 707 Posts

Renee Dustman, BS, AAPC MACRA Proficient, is an executive editor at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 20 years experience in print production and content management. Follow her on Twitter @dustman_aapc.

2 Responses to “Annual Checkup: Medicare Policies for Code Updates”

  1. stephanie Canfield says:

    thank you for sending out the new updates! I need to retake the exam although I do have my certificate from Penn State University but so nervous about the exam. I want so much to be able to work with the coding .

  2. Becky says:

    90853 group code lacks a time measure. If it’s 1 hour or 3 hours all insurances but Medicaid only allow 1 unit. How can this be changed? Or am I missing a code/modifier?

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