lcd

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    Wiki Aetna Medicare denying Venous Studies

    Aetna Medicare has started denying venous studies (CPT 93970 & 93971) due to frequency. They cite CMS LCD & Article as it only allows one per year. No other payers including Medicare are following the LCD. Any suggestions?
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    Wiki LCDs and Jurisdictions

    Hello, Two quick question on how LCDs work. 1. Do the LCDs that pertain to one state in a particular MAC's jurisdiction apply to all the states in that same jurisdiction? For example, Maine and Vermont are both in Jurisdiction K with NGS. Are the LCDs the same for both states? 2. New York...
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    Wiki HCPCS L1851 - M17.11 supports alone for a Medicare JC audit?

    The LCD and article are stumping me in their verbiage for the medical necessity of the knee brace L1851. The LCD L33318 states: When I checked the group 4 ICD-10 codes, M17.11 (unilateral primary osteoarthritis, right knee) is listed in the LCD-related policy article, A52465. However, L33318...
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    Wiki Allergy Testing Medicare Denials

    We just started seeing A TON of denials for allergy skin testing (CPT 95004) from Medicare. They said it's due to medical necessity/insufficient documentation and that we have been using non-covered ICD-10 codes since the LCD update on 7/11/2021 (L36241). I reviewed the updated LCD and can't...
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    Wiki Palmetto GBA LCD L33445 removal of skin lesions

    Palmetto GBA became our MAC at the beginning of the year. With that comes their LCD L33445 Removal of Benign and Malignant Skin Lesions with (or in this case without) a different set of "covered" or "deemed medically necessary" ICD-10 codes. This has really shook the physicians in terms of...
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    Wiki D22.XX codes BX proven for reshave and Excision HELP

    we visited this topic at one point a year ago or more but I has come up again. This is a derm office in PA where MediCare LCD doesn't accept D22.XX (Dysplastic Nevi) under the shave codes or excision codes they deny as not necessary as they are benign spots. The process is BX is done on one...
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    Wiki LCD for Benign Skin Lesions

    I am wondering about how to code medical necessity for benign skin lesions for Medicare. LCD L34233 (Noridian) says the following: Medicare will consider the removal of benign skin lesions as medically necessary, and not cosmetic, if one or more of the following conditions is present and...
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    Wiki Need help locating Noridian MAC LCD

    I just recently started coding for an anesthesiologist in Northern California. Does anybody know for sure if Noridian has an LCD for that jurisdiction? I was told to use L34100 ...
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    Wiki Tilt Table

    I'm getting denials on Tilt Tables. We are using R55 as the ICD 10 code. I've tried looking for the LCD or NCD on 93660 and had no luck. Any suggestions?
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    Wiki NCD/LCD for 17000

    In Arkansas there is an LCD for the use of 17000 & 17003 for 702.0(actinic keratoses). However, I have never had this CPT and ICD combination denied by Medicare. Recently I had a Medicaire Advantage plan deny a claim with these codes based on the LCD. i asked my providers to have ABNs signed...
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