Posted 04/27/2023-Under Coding Information CPT/HCPCS Codes added Group 9 Paragraph-The following CPT/HCPCS codes are non-covered and added Group 9 Codes 0525T-0532T.
Posted 04/28/2022 - corrected Revision Effective Date from 06/11/2022 to 06/12/2022 to correspond with Effective Date of LCD L35490.
Posted 04/27/2022. Under Article Guidance added Frequency Limitation Medicare may cover only 1 unit per eye, per date of service of CPT code 0449T for insertion of glaucoma drainage device(s) into the subconjunctival space (e.g., XEN45®), when the medically reasonable and necessary criteria as stated in the LCD are met. Added Documentation Requirements 1)All documentation must be maintained in the patient's medical record and must support the medical necessity of the services as directed in this article and be made available to the contractor upon request, 2) Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service(s)).The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient, and 3) The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.
Under Group 4 Paragraph added H40.10X1, H40.10X2, H40.1111, H40.1112, H40.1121, H40.1122, H40.1131, H40.1132, H40.1211, H40.1212, H40.1213, H40.1214, H40.1221, H40.1222, H40.1223, H40.1224, H40.1231, H40.1232, H40.1233, H40.1234, H40.1311, H40.1312, H40.1321, H40.1322, H40.1323, H40.1331, H40.1332, H40.1411, H40.1412, H40.1421, H40.1422, H40.1431, and H40.1432 to Group 4 Codes. Under Group 5 Paragraph added G20 to Group 5 Codes.
12/30/2021 Annual CPT/HCPCS code updates. Under Article Guidance Article Text removed information related to deleted CPT codes 0466T and 0355T. Deleted Group 1 codes 0191T, 0376T, 0548T, 0549T, 0550T and 0551T. Under CPT/HCPCS Codes deleted Group 4 Paragraph information and deleted Group 4 Codes 0191T and 0376T. Deleted Group 9 Paragraph and Group 9 codes 0548T, 0549T, 0550T, 0551T Under ICD-10 Codes that Support Medical Necessity Group 2 Paragraph deleted CPT codes 0191T and 0376T. Deleted all of Group 6 Paragraph and Group 6 Codes.
03/11/2021 Added to Article Text: CPT Codes 0501T-0504T: Please refer to L38839 Non-Invasive Fractional Flow Reserve (FFR) for Stable Ischemic Heart Disease and A58473 Billing and Coding: Non-Invasive Fractional Flow Reserve (FFR) for Stable Ischemic Heart Disease for Coverage Indications, Limitations, and/or Medical Necessity. Removed CPT/HCPCS Codes/Group 1 Codes: 0501T-0504T. Removed Group 9 Paragraph/Group 9 Codes: 0501T-0504T. Removed ICD-10 Codes that Support Medical Necessity/Group 5 Paragraph: The following ICD-10 Codes are used to support medical necessity with CPT codes 0501T, 0502T, 0503T and 0504T. Removed Group 5 Codes. Reformatted numerical order. Effective 04/25/2021.
02/11/2021 Added to Article Text: CPT code 0355T. Please refer to L38837 Colon Capsule Endoscopy (CCE) and A58471 Billing and Coding: Colon Capsule Endoscopy (CCE). The provider performing this service must meet all criteria in that LCD and Billing and Coding Article. Effective 03/28/2021.
12/31/2020 2021 CPT/HCPCS Annual code update: 0295T, 0296T, 0297T, and 0298T deleted. Effective 01/01/2021. Please refer to LCD L34636 Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring) and A57476 Billing and Coding: Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring). Reformatted Article Text: CPT Code 0466T. Added to Article Text: CPT code 0421T and HCPCS code C2596. Included reference to related LCD L38682 and Article A56902 which became effective 12/27/2020.
11/26/2020: Updated Group 3 Paragraph: 0075T and 0076T: Please refer to the CPT Professional code book: use 0076T in conjunction with 0075T. Corrected Group 10 Paragraph: CPT code corrected from 0450T to CPT code 0550T. Included: Please refer to the CPT Professional code book: do not report 0551T in conjunction with 0548T, 0549T, 0550T.
10/29/2020: Please note correction for 06/25/2020 revision history: 098T should have read 0298T.
Added to article text: CPT Codes 0446T- Creation of subcutaneous pocket with insertion of implantable interstitial glucose sensor, including system activation and patient training, 0447T- Removal of implantable interstitial glucose sensor from subcutaneous pocket via incision, and 0448T- Removal of implantable interstitial glucose sensor with creation of subcutaneous pocket at different anatomic site and insertion of new implantable sensor, including system activation. Please refer to L38686 Implantable Continuous Glucose Monitors (I-CGM) and A58213 Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM). The physician (MD/DO) performing the service must meet all criteria in this LCD and Billing and Coding Article. Effective 10/11/2020. Coding Information Group 1 Paragraph: updated statement to include associated Billing and Coding Article. Removed medical necessity information and relocated to LCD L35490 to Summary of Evidence in Group 2 Paragraph 0042T; Group 7 Paragraph 0398T; and Group 9 Paragraph: 0501T, 0502T, 0503T, 0504T. Group 3 Paragraph: 0075T and 0076T. Removed reference CMS publication 100-03, Medicare National Coverage Determinations (NCD) Manual as it is located in the LCD: Utilization Guidelines. Group 4 Paragraph: removed medical description of CPT code 0191T, located in Utilization Guidelines. Group 6 Paragraph: 0308T reformatted billing guidance. Group 8 Paragraph: 0449T, 0450T removed medical description of CPT codes, located in Utilization Guidelines. Group 10 Paragraph: 0548T, 0549T, 0550T, 0551T removed medical descriptions, located in Utilization Guidelines.
Removed medical necessity information and relocated to LCD L35490 to Utilization Guidelines in Group 3 Paragraph 0075T-0076T; Group 4 Paragraph 0191T; Group 6 Paragraph 0308T; Group 8 Paragraph: 0449T, 0450T and Group 10 Paragraph: 0548T, 0549T, 0550T, 0551T.
06/25/2020: CPT/HCPCS Codes Group 1 Codes added: 0042T, 0275T, 0398T, 0501T, 0502T, 0503T, 0504T, 0548T, 0549T, 0550T, and 0551T. CPT/HCPCS Codes Group 1 Codes removed: 0295T, 0296T, 0297T, and 098T. The billing and coding information for these 4 CPT codes are dependent on the coverage indications, limitations and/or medical necessity described in the LCD L34636 Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring) and A57476 Billing and Coding: Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring). Updated content:
Group 2 Paragraph: 0042T; Utilization Guidelines reformatted and includes: Group 3 Paragraph: 0075T and 0076T; Group 4 Paragraph: 0191T; Group 6 Paragraph: 0308T; Group 7 Paragraph: 0398T; Group 8 Paragraph: 0449T, 0450T; Group 9 Paragraph: 0501T, 0502T, 0503T, 0504T; and Group 10 Paragraph: 0548T, 0549T, 0550T, 0551T. ICD-10 Codes that Support Medical Necessity Group 1 Paragraph: 0042T, Group 1 Codes: I63.031, I63.032, I63.131, I63.132, I63.311, I63.312, I63.411, I63.412, I63.511, and I63.512. Reformatted Group 2 Codes through Group 7 Codes for correct numerical order.
04/30/2020: Article text includes new format “with the exception of the following CPT codes:” Added: CPT Codes 0295T - 0298T. Please refer to A54953 Independent Diagnostic Testing Facilities – physician supervision and technician requirements. Additional guidance provided in LCD L34636 Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring) and A57476 Billing and Coding: Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring). The physician (MD/DO) performing the service must meet all criteria in this LCD and Billing and Coding Article. (Effective 04/30/2020).
CPT Codes 0466T- 0468T. Please refer to L38528 - Hypoglossal Nerve Stimulation for Treatment of Obstructive Sleep Apnea and A57944 Billing and Coding: Hypoglossal Nerve Stimulation for Treatment of Obstructive Sleep Apnea. The physician (MD/DO) performing the service must meet all criteria in this LCD and Billing and Coding Article. (Future Effective 06/14/2020) Last review completed 04/06/2020.
12/19/2019 CPT/HCPCS annual code update: deleted CPT 0249T from Group 1 Codes and associated L35490 effective 01/01/2020. Providers are responsible for determining the correct diagnostic and procedural coding for the services they furnish to Medicare beneficiaries.
Content has been moved to the new template.
09/26/2019: Group 4 Paragraph: removed I48.1 and I48.2 are applicable to Group 4 Paragraph. ICD-10 CM annual code updates: Group 4 added codes I48.11, I48.19, I48.20, and I48.21.