Active/Final LCDs - November
CMS Medicare Coverage Database 
- What is a Local Coverage Determination (LCD)?
- What is a National Coverage Determination (NCD)?
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 National Coverage Provision (NCP)?
Important Note: Please read all policy documents. The billing and coding guidelines document is a supplement to the policy. The policy describes the indications, limitations of coverage, and/or medical necessity of the services or procedures. It is important to read both documents.
Allergy
ALRG-001 Allergy Testing and Allergy Immunotherapy | Billing Guidelines
Ambulance
Anesthesia
AN-030 Moderate (Conscious) Sedation
Cardiovascular
CV-004 Cardiovascular Stress Testing | Billing Guidelines
CV-006 Cardiac Catheterization and Coronary Angiography | Billing Guidelines
CV-007 Transesophageal Echocardiography (TEE) | Billing Guidelines
CV-012 Cardiac Rehabilitation Programs | Billing Guidelines
CV-014 Automatic Implantable Cardioverter Defibrillator | Billing Guidelines
CV-016 Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring) | Billing Guidelines - Retire 10/16/2009
CV-016 Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring) | Billing Guidelines - EFFECTIVE 10/16/2009
CV-017 Myocardial Perfusion Imaging | Billing Guidelines
CV-026 Transthoracic Echocardiography (TTE) | Billing Guidelines
CV-027 Dialysis Shunt Maintenance | Billing Guidelines
CV-028 Non-Coronary Vascular Stents/Endovascular Graft Placement | Billing Guidelines
CV-029 Transmyocardial Revascularization (TMR) | Billing Guidelines
CV-033 Noninvasive Vascular Testing (N.I.V.T.) | Billing Guidelines
CV-036 T-Wave Alternans Testing | Billing Guidelines
CV-037 Percutaneous Coronary Interventions (PCI) | Billing Guidelines
CV-039 Percutaneous Transluminal Angioplasty (PTA) (Carotid Stents) | Billing Guidelines
CV-040 Cardiac Rhythm Device Evaluation | Billing Guidelines
CV-041 Ultrasound Screening for Abdominal Aortic Aneurysms (AAA)
Chiropractic
CHIRO-001 Chiropractic Services | Billing Guidelines
Dental
DENT-002 Dental Services | Billing Guidelines
Integumentary
DERM-004 Mohs' Micrographic Surgery (MMS) | Billing Guidelines
DERM-008 Removal of Benign Skin Lesions
DERM-009 Treatment of Actinic Keratosis (AK) | Billing Guidelines
Otorhinolaryngology
ENT-006 Audiology Services | Billing Guidelines
ENT-012 Surgical Treatment of Obstructive Sleep Apnea (OSA) | Billing Guidelines
Foot Care
FT-001 Foot Care | Billing Guidelines
Gastrointestinal
GI-006 Colonoscopy and Sigmoidoscopy-Diagnostic
GI-008 Colorectal Cancer Screening Benefit
GI-009 Telemetric Gastrointestinal Capsule Imaging | Billing Guidelines - Retired Effective 12/15/2009
GI-009 Telemetric Gastrointestinal Capsule Imaging | Billing Guidelines - EFFECTIVE 12/16/2009
General Surgery
GSURG-021 Liver Transplantation | Billing Guidelines
GSURG-031 Heart and/or Lung Transplants | Billing Guidelines
GSURG-032 Cosmetic and Reconstructive Surgery | Billing Guidelines
GSURG-033 Ablative Therapy | Billing Guidelines
GSURG-034 Intra-operative Neurophysiological Testing | Billing Guidelines
GSURG-035 Pancreas Transplants with Kidney Transplant and Pancreas Transplant Alone | Billing Guidelines
GSURG-036 Sentinel Lymph Node Biopsy | Billing Guidelines
GSURG-037 Application of Bioengineered Skin Substitutes and Skin Grafting | Billing Guidelines - Retire effective 10/16/09 [Replaced with GSURG-052]
GSURG-038 Intestinal and Multi-Visceral Transplantation | Billing Guidelines
GSURG-039 Sacral Nerve Stimulation for Urinary Incontinence | Billing Guidelines
GSURG-041 The Treatment of Varicose Veins of the Lower Extremities | Billing Guidelines - Retire 11/14/2009
GSURG-041 Treatment of Varicose Veins of the Lower Extremities | Billing Guidelines - EFFECTIVE 11/15/2009
GSURG-042 Bariatric Surgery for Morbid Obesity | Billing Guidelines
GSURG-043 Posterior tibial nerve stimulation (PTNS)
GSURG-050 Stereotactic Computer Assisted Volumetric and/or Navigational Procedure
GSURG-052 Application of Bioengineered Skin Substitutes - Retire 10/16/2009
GSURG-052 Application of Bioengineered Skin Substitutes | Billing Guidelines - EFFECTIVE 10/16/2009
Genitourinary
GU-003 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer | Billing Guidelines
GU-016 The Evaluation and Treatment of Erectile Dysfunction | Billing Guidelines - Retired Effective 12/01/2009
GU-020 Diagnostic PAP Tests | Billing Guidelines
Hematology/Oncology/Lymphatic
HONC-002 Chemotherapy and Drug Administration
HONC-009 Bone Marrow or Stem Cell Transplantation | Billing Guidelines
HONC-010 Chemotherapy Drugs and their Adjuncts | Billing Guidelines
HONC-019 Extracorporeal Immunoadsorption (ECI) Using Protein A Columns & Apheresis (Therapeutic Pheresis) | Billing Guidelines
Injections (Drugs)
INJ-003 Hemophilia Clotting Factors
INJ-004 Vitamin B-12 Injections
INJ-012 Immune Globulins - Retire 11/14/2009
INJ-012 Immune Globulins - EFFECTIVE 11/15/2009
INJ-018 Treatment with Botulinum Toxin Type A & Type B | Billing Guidelines
INJ-019 Human Granulocyte/Macrophage Colony Stimulating Factors
INJ-023 Erythropoiesis Stimulating Proteins Epoetin alfa (EPO), Darbepoetin alfa (DPA) | Billing Guidelines
INJ-025 Bisphosphonate Drug Therapy - Retire 10/16/2009
INJ-025 Bisphosphonate Drug Therapy - EFFECTIVE 10/16/2009
INJ-029 RhO (D) Immune Globulin | Billing Guidelines
INJ-033 Intra-articular Injections of Hyaluronate for Treatment of Osteoarthritis of the Knee | Billing Guidelines - Retire 10/16/2009
INJ-033 Intra-articular Injections of Hyaluronate | Billing Guidelines - EFFECTIVE 10/16/2009
INJ-034 Thrombopoietic Growth Factor - Oprelvekin (Neumega™) - Retire 11/14/2009
INJ-034 Thrombopoietic Growth factor - Oprelvekin - EFFECTIVE 11/15/2009
INJ-035 Intravenous Iron Therapy | Billing Guidelines
INJ-036 Levocarnitine for Use in the Treatment of Carnitine Deficiency in ESRD Patients
INJ-038 Intravenous immune globulin for the treatment of autoimmune mucocutaneous blistering diseases | Billing Guidelines
INJ-039 Gonadotropin-Releasing Hormone Analogs | Billing Guidelines
INJ-040 Erythropoiesis Stimulating Agents (ESAs) in Cancer and Related Neoplastic Conditions | Billing Guidelines
Musculoskeletal
MS-004 Bone Mass Measurement | Billing Guidelines
MS-007 Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma | Billing Guidelines - EFFECTIVE 10/16/2009
MS-008 Trigger Points, Local Injections - EFFECTIVE 10/16/2009
Neurology
NEURO-003 Deep Brain Stimulation for Essential Tremor and Parkinsons' Disease
NEURO-004 Vagus Nerve Stimulation | Billing Guidelines
NEURO-005 Nerve Conduction Studies and Electromyography | Billing Guidelines
Ophthalmology
OPHTH-003 Optometrist Services | Billing Guidelines
OPHTH-006 Ophthalmic Biometry | Billing Guidelines
OPHTH-014 Computerized Corneal Topography | Billing Guidelines
OPHTH-015 Optical Coherence Tomography (OCT) | Billing Guidelines - Retire 10/16/2009
OPHTH-015 Optical Coherence Tomography (OCT) | Billing Guidelines - EFFECTIVE 10/16/2009
OPHTH-016 Angiography - Retinal/Choroidal with Fluorescein or Indocyanine Green | Billing Guidelines
OPHTH-022 Blepharoplasty, Blepharoptosis and Brow Lift | Billing Guidelines
OPHTH-023 Verteporfin (Visudyne TM) and Ocular Photodynamic Therapy (OPT) | Billing Guidelines
OPHTH-025 Corneal Pachymetry | Billing Guidelines
Pathology
For an index of Laboratory NCDs, please see the CMS Website http://www.cms.hhs.gov/mcd/indexes.asp
PATH-016 Flow Cytometry - Retire 11/16/2009
PATH-016 Flow Cytometry - EFFECTIVE 11/16/2009
PATH-026 Helicobacter Pylori Testing | Billing Guidelines - Retire 10/16/2009
PATH-026 Helicobacter Pylori Testing | Billing Guidelines - EFFECTIVE 10/16/2009
PATH-027 Cytogenetic Studies | Billing Guidelines
PATH-028 Heavy Metal Testing | Billing Guidelines
PATH-031 Syphilis Test | Billing Guidelines
Physician Services
PHYS-004 Incident To a Physician's Professional Service in the Office or Clinic
PHYS-021 Emergency Department Services
PHYS-034 Nurse Practitioners/Clinical Nurse Specialists
PHYS-041 Nutrition Training Benefits
PHYS-042 Drugs and Biologicals - Coverage and Payment
PHYS-050 Certified Nurse Midwife
PHYS-056 Hyperbaric Oxygen Therapy
PHYS-066 Biofeedback | Billing Guidelines
PHYS-068 Coverage of Services and Procedures in Nursing Facilities
PHYS-072 Ambulatory Blood Pressure Monitoring | Billing Guidelines
PHYS-075 Physician Supervision of Diagnostic Tests
PHYS-076 Biofeedback Therapy for the Treatment of Urinary Incontinence
PHYS-077 Clinical Trials | Billing Guidelines
*Appendix RevisedPHYS-078 Independent Diagnostic Testing Facilities (IDTFs) | Billing Guidelines
PHYS-079 Nursing Facility Services (Codes 99304 - 99318)
PHYS-081 Home and Domiciliary Services | Billing Guidelines
Physical Medicine
PHYSMED-012 Electrical Stimulation (ES) and Electromagnetic Therapy for the Treatment of Wounds | Billing Guidelines
Psychiatry/Psychology
PSYCH-002 Clinical Psychologists Services
PSYCH-009 Clinical Social Worker Services
PSYCH-012 Outpatient Mental Health Treatment Payment Limitation (Psych Limit)
PSYCH-013 Psychological Services under the "Incident to" Provision | Billing Guidelines
PSYCH-014 Psychiatry and Psychology Services | Billing Guidelines
PSYCH-015 Health and Behavior Assessment/Intervention | Billing Guidelines
Pulmonary
PULM-003 Sleep Disorder Clinics and Diagnostic Tests
Radiology
RAD-005 Diagnostic Mammograms | Billing Guidelines
RAD-014 Radiation Oncology Including Intensity Modulated Radiation Therapy (IMRT) | Billing Guidelines
RAD-018 Cranial Stereotactic Radiosurgery (SRS) and Cranial Stereotactic Radiotherapy (SRT) | Billing Guidelines
RAD-023 Magnetic Resonance Angiography (MRA) | Billing Guidelines
RAD-024 Magnetic Resonance Imaging (MRI) | Billing Guidelines
RAD-026 Radiopharmaceutical Agents | Billing Guidelines
RAD-028 Percutaneous Image-Guided Breast Biopsy
RAD-032 Vertebroplasty (Percutaneous) and Kyphoplasty | Billing Guidelines
RAD-033 Computerized Tomography (CAT Scans) | Billing Guidelines
RAD-034 Computed Coronary Tomography Angiography | Billing Guidelines
RAD-035 CT Colonography (Virtual Colonoscopy) | Billing Guidelines - Retire effective 11/15/2009
RAD-035 CT Colonography (Virtual Colonoscopy [VT]) | Billing Guidelines - EFFECTIVE 11/15/2009
RAD-036 Brachytherapy | Billing Guidelines
RAD-037 3D Interpretation and Reporting of Imaging Studies | Billing Guidelines
RAD-038 Selective Internal Radiation Therapy (SIRT) for Primary and Secondary Hepatic Malignancy (90Y-Microsphere Hepatic Brachytherapy) - Retire 10/16/2009
RAD-038 Selective Internal Radiation Therapy (SIRT) for Primary and Secondary Hepatic Malignancy (90Y-Microsphere Hepatic Brachytherapy) - EFFECTIVE 10/16/2009
RAD-039 Stereotactic Body Radiation Therapy
NOTE: Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material that is copyrighted by the American Medical Association. You are forbidden to download the files unless you read, agree to, and abide by the provisions of the copyright statement. Read the copyright statement now and you will be linked back to here.
Page Last Updated: Tuesday, 17-Nov-2009 08:25:09 CST
