Part B Active/Final Policies

Home Provider Part B Policies/Coverage

Please click on the title of the policy to link to the policy on our Website.
WPS Medicare does not post all Part B Legacy National Coverage Determinations (NCDs) on our Website. We post NCDs that providers most frequently request clarification on. To access all NCDs, please visit the Centers for Medicare & Medicaid Services (CMS) Medicare Coverage Database.

• What is a Local Coverage Determination (LCD)?
• What is a National Coverage Determination (NCD)?
• What is a National Coverage Provision (NCP)?

WPS Medicare Part B Final Policies May

	Allergy
	Allergy Testing and Allergy Immunotherapy	ALRG-001
	Immunizations	ALRG-003
	Ambulance
	Ambulance Services***NCP	AMB-001
	Ambulatory Surgical Centers (ASCs)
	Ambulatory Surgical Centers (ASCs)***NCP	ASC-001
	Anesthesia
	Anesthesia Services***NCP	AN-001
	Cardiovascular
	Cardiac Stress Testing	CV-004
	Cardiac Catheterization and Coronary Angiography	CV-006
	Transesophageal Echocardiography (TEE)	CV-007
	Cardiac Rehabilitation Programs	CV-012
	Automatic Implantable Cardioverter Defibrillator	CV-014
	Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring)	CV-016
	Myocardial Perfusion Imaging	CV-017
	Transthoracic Echocardiography	CV-026
	Dialysis Shunt Maintenance	CV-027
	Non-Coronary Vascular Stents/Endovascular Graft Placement	CV-028
	Transmyocardial Revascularization (TMR)	CV-029
	Insertable Loop Recorder (ILR)	CV-032
	Noninvasive Vascular Testing (N.I.V.T.)	CV-033
	Intraoperative Transesophageal Echocardiography(TEE)	CV-034
	Intravascular Brachytherapy (IVBT)	CV-035
	T-Wave Alternans Testing	CV-036
	Percutaneous Coronary Interventions (PCI)	CV-037
	Percutaneous Transluminal Angioplasty (PTA) (Carotid Stents)	CV-039
	Cardiac Rhythm Device Evaluation	CV-040
	Ultrasound Screening for Abdominal Aortic Aneurysms (AAA)	CV-041
	Chiropractic
	Chiropractic Services	CHIRO-001
	Dental
	Dental Services ***NCP	DENT-002
	Integumentary
	Mohs' Micrographic Surgery (MMS)	DERM-004
	Removal of Benign Skin Lesions	DERM-008
	Treatment of Actinic Keratosis (AK)	DERM-009
	Otorhinolaryngology
	Audiology Services ***NCP	ENT-006
	Surgical Treatment of Obstructive Sleep Apnea (OSA)	ENT-012
	Foot Care
	Foot Care ***NCP	FT-001
	Gastrointestinal
	Diagnostic Sigmoidoscopy and Colonoscopy	GI-006
	Colorectal Cancer Screening Benefit	GI-008
	Telemetric Gastrointestinal Capsule Imaging	GI-009
	General Surgery
	Surgery***NCP	GSURG-001
	Liver Transplantation	GSURG-021
	Heart and/or Lung Transplants	GSURG-031
	Cosmetic and Reconstructive Surgery	GSURG-032
	Cryosurgery for Liver Tumors	GSURG-033
	Intra-operative Neurophysiological Testing	GSURG-034
	Pancreas Transplants with Kidney Transplant and Pancreas Transplant Alone	GSURG-035
	Sentinel Lymph Node Biopsy	GSURG-036
	Application of Bioengineered Skin Substitutes and Skin Grafting	GSURG-037
	Intestinal and Multi-Visceral Transplantation	GSURG-038
	Sacral Nerve Stimulation for Urinary Incontinence	GSURG-039
	The Treatment of Varicose Veins of the Lower Extremities	GSURG-041
	Bariatric Surgery for Morbid Obesity	GSURG-042
	Genitourinary
	Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer	GU-003
	The Treatment of Benign Prostatic Hyperplasia (BHP)	GU-015
	The Evaluation and Treatment of Erectile Dysfunction	GU-016
	Diagnostic PAP Tests	GU-020
	Hematology / Oncology / Lymphatic
	Chemotherapy and Drug Administration***NCP	HONC-002
	Bone Marrow or Stem Cell Transplantation	HONC-009
	Antineoplastics and their Adjuncts	HONC-010
	Extracorporeal Immunoadsorption (ECI) Using Protein A Columns & Apheresis (Therapeutic Pheresis)	HONC-019
	Injections (Drugs)
	Hemophilia Clotting Factors ***NCP	INJ-003
	Vitamin B-12 Injections	INJ-004
	Immune Globulins	INJ-012
	Treatment with Botulinum Toxin Type A & Type B	INJ-018
	Human Granulocyte/Macrophage Colony Stimulating Factors	INJ-019
	Erythropoiesis Stimulating Proteins Epoetin alfa (EPO), Darbepoetin alfa (DPA)	INJ-023
	Bisphosphonate Drug Therapy	INJ-025
	RhO (D) Immune Globulin	INJ-029
	Intra-articular Injections of Hyaluronate for Treatment of Osteoarthritis of the Knee	INJ-033
	Thrombopoietic Growth Factor - Oprelvekin (Neumega™)	INJ-034
	Intravenous Iron Therapy	INJ-035
	Levocarnitine for Use in the Treatment of Carnitine Deficiency in ESRD Patients	INJ-036
	Alefacept Therapy	INJ-037
	Intravenous immune globulin for the treatment of autoimmune mucocutaneous blistering diseases	INJ-038
	Gonadotropin-Releasing Hormone Analogs	INJ-039
	Erythropoiesis Stimulating Agents (ESAs) in Cancer and Related Neoplastic Conditions	INJ-040
	Musculoskeletal
	Bone Mass Measurement	MS-004
	Neurology
	Deep Brain Stimulation for Essential Tremor and Parkinsons' Disease	NEURO-003
	Vagus Nerve Stimulation	NEURO-004
	Nerve Conduction Studies and Electromyography	NEURO-005
	Ophthalmology
	Optometrist Services	OPHTH-003
	Ophthalmic Biometry	OPHTH-006
	Computerized Corneal Topography	OPHTH-014
	Optical Coherence Tomography (OCT)	OPHTH-015
	Angiography - Retinal/Choroidal with Fluorescein or Indocyanine Green	OPHTH-016
	Blepharoplasty, Blepharoptosis and Brow Lift	OPHTH-022
	Verteporfin (Visudyne TM) and Ocular Photodynamic Therapy (OPT)	OPHTH-023
	Corneal Pachymetry	OPHTH-025
	Pathology
	For an index of Laboratory NCDs, please see: http://www.cms.hhs.gov/mcd/indexes.asp
	Clinical Lab and Reference Laboratory Services ***NCP	PATH-001
	Pathology - Physician Services***NCP	PATH-002
	Flow Cytometry	PATH-016
	Helicobacter Pylori Testing	PATH-026
	Cytogenetic Studies	PATH-027
	Heavy Metal Testing	PATH-028
	Syphilis Test	PATH-031
	Physician Services
	General Coverage of Physician Services***NCP	PHYS-001
	Incident To a Physician's Professional Service in the Office or Clinic***NCP	PHYS-004
	Consultations ***NCP	PHYS-006
	Emergency Department Services ***NCP	PHYS-021
	Critical Care***NCP	PHYS-022
	Supervising Physicians in Teaching Settings***NCP	PHYS-024
	Physician Assistants***NCP	PHYS-026
	Nurse Practitioners / Clinical Nurse Specialists***NCP	PHYS-034
	Influenza, Pneumococcal, and Hepatitis-B Vaccinations***NCP	PHYS-040
	Nutrition Training Benefits	PHYS-041
	Drugs and Biologicals - Coverage and Payment***NCP	PHYS-042
	Certified Nurse Midwife***NCP	PHYS-050
	Hyperbaric Oxygen Therapy	PHYS-056
	Biofeedback	PHYS-066
	Medical Devices  ***NCP	PHYS-067
	Coverage of Services and Procedures in Nursing Facilities	PHYS-068
	Ambulatory Blood Pressure Monitoring	PHYS-072
	Physician Supervision of Diagnostic Tests  ***NCP	PHYS-075
	Biofeedback Therapy for the Treatment of Urinary Incontinence	PHYS-076
	Clinical Trials	PHYS-077
	Independent Diagnostic Testing Facilities (IDTFs)	PHYS-078
	Nursing Facility Services (Codes 99304 - 99318)  ***NCP	PHYS-079
	No Cost Items  ***NCP	PHYS-080
	Home and Domiciliary Services	PHYS-081
	Physical Medicine
	Outpatient Physical Therapy, Occupational Therapy and Speech-Language Pathology***NCP	PHYSMED-001
	Physical Medicine and Rehabilitation Procedures and Modalities	PHYSMED-009
	Electrical Stimulation (ES) and Electromagnetic Therapy for the Treatment of Wounds	PHYSMED-012
	Psychiatry / Psychology
	Clinical Psychologists Services***NCP	PSYCH-002
	Clinical Social Worker Services ***NCP	PSYCH-009
	Outpatient Mental Health Treatment Payment Limitation (Psych Limit) ***NCP	PSYCH-012
	Psychological Services under the "Incident to" Provision	PSYCH-013
	Psychiatry and Psychology Services	PSYCH-014
	Health and Behavior Assessment/Intervention	PSYCH-015
	Pulmonary
	Sleep Disorder Clinics and Diagnostic Tests***NCP	PULM-003
	Radiology
	Radiologic Examination of the Chest, Including Portable	RAD-004
	Diagnostic Mammograms	RAD-005
	Radiation Oncology Including Intensity Modulated Radiation Therapy (IMRT)	RAD-014
	Screening Mammography ***NCP	RAD-016
	Cranial Stereotactic Radiosurgery (SRS) and Cranial Stereotactic Radiotherapy (SRT)	RAD-018
	Magnetic Resonance Angiography (MRA)	RAD-023
	Magnetic Resonance Imaging (MRI)	RAD-024
	Radiopharmaceutical Agents	RAD-026
	Positron Emission Tomography (PET) Scans	RAD-027
	Percutaneous Image-Guided Breast Biopsy	RAD-028
	Vertebroplasty (Percutaneous) and Kyphoplasty	RAD-032
	Computerized Tomography (CAT Scans)	RAD-033
	Computed Coronary Tomography Angiography	RAD-034
	CT Colonography (Virtual Colonoscopy)	RAD-035
	Brachytherapy	RAD-036
	3D Interpretation and Reporting of Imaging Studies	RAD-037
	Selective Internal Radiation Therapy (SIRT) for Primary and Secondary Hepatic Malignancy (90Y-Microsphere Hepatic Brachytherapy)	RAD-038
	Graphic Key
	Signifies a recent revision to the coding and billing article associated with this particular policy
	Local Coverage Determination
	National Coverage Determination
***NCP	National Coverage Provison in Interpretive Manuals

Page Last Updated: Friday, 16-May-2008 16:14:33 CDT