Wiki Urgent: 64450 - Peripheral nerve blocks - New update from Medicare?

[Biller2023]

I attached a screenshot. Can someone please review this and tell me when this will take effect? Is this only for Medicare or also for medicare advantage, private insurances and medicaid plans.

Any reason why they are making this change?

 

[jkyles]

Hi there, the MACs haven't finalized this policy and there's still time to submit a comment. I recommend pulling up your MAC's proposed LCD and reviewing it for the reasoning. You can submit a comment from the LCD.

If your MAC decides to finalize this LCD it will issue a notice period to give providers time to prepare and it would only apply to the MAC, not other payers.

 

[Biller2023]

Thank you for your reply,
So when I go to novitas solutions, select JL and then go to LCD policy search > nothing comes up when I search for 64450. I also clicked on Active LCDs and articles interactive search and this automatically takes me to JH and not JL. From this page when I clicked on proposed LCD, I couldn't find 64450, so is this not listed in proposed LCD?

 

[jkyles]

Is Novitas your MAC? Novitas hasn't issued the proposed uniform LCD discussed in the announcement.

 

[amyjph]

Don't overreact. It is proposed, not final yet. If you read the release from ASIPP it says except Novitas and FCSO, "All Medicare Administrative Contractors (MACs), including CGS, NGS, Noridian, Palmetto, and WPS, except Novitas and First Coast Service Options, have released new Local Coverage Determinations (LCDs) for peripheral nerve blocks and procedures for chronic pain." The release also gives all the links to give comment if desired. It usually takes around 6-12 months before anything happens.
This explains how it works: https://www.novitas-solutions.com/webcenter/portal/MedicalPolicy_JL/Process

https://www.cms.gov/medicare/coverage/determination-process/local

https://www.cms.gov/medicare/coverage/determinationprocess/downloads/lcd_qsas.pdf

 

[Biller2023]

Yes, novitas is our MAC. Thank you!