Wiki LCD for CPT 64626 & 64627

[NESmith]

When Medicare does a revised version of an LCD and the effective date of one is 02/02/09 & the second one is 03/02/09 & the third is 09/30/09 I know you would follow the newest one. Here is my question and I hope I address this correctly. On the first two LCD there was no limit of destructions but on the newest one there is a limit now of 5 levels unilaterally or bilaterally on the same date of service and that it is not expected that repeat destruction at the same level will exceed 2 treatments within a 12 month(365 days) period of time. Does that 12 month period start on the new LCD effective date of does that mean 12 months from the last proedure? Thanks for your help

 

[dwaldman]

For the carrier we use WPS Medicare on their site there is way to email them a question and someone emails or calls back to help clarify. In this particular case you might want to do this. Because you are saying if the Doctor did an RF of L2-L5 on the right side two times before the requirement took effect than he wants to do a third of the same levels same side after the effective date but the policy says only two in one year of same level same side. I personally think they could only start monitoring how many times the procedure was performed for dates of service after the effective date. But this is just a quess. If don't get another post that answers your question you could email the medicare carrier.

 

[tadavis]

I think you use the new rules on that effective date. It the date of service is prior to the new rule then you continue to use the old rule until you catch up to the new effective date. But you can call medicare provider outreach and education service at 800-338-6101 (for kentucky area)

 

[hgolfos]

I agree with both the above. The new LCD probably should not be retro to previous dates of service. From what I've seen of WPS, NGS, and CMS LCDs, the dates of service on or after effective/implementation date would be the ones affected.