Local Coverage Determination for Colorectal Cancer Screening (L29796)

Transcription

1 Page 1 of 15 Home Medicare Medicaid CHIP About CMS Regulations & Guidance Research, Statistics, Data & Systems Outreach & E People with Medicare & Medicaid Questions Careers Newsroom Contact CMS Acronyms Help Back to Local Coverage Determinations (LCDs) for NHIC, Corp. (14502, MAC - Part B) Local Coverage Determination (LCD) for Colorectal Cancer Screening (L29796) Select the Print Record, Add to Basket or Record buttons to print the record, to add it to your basket or to the record. Section Navigation Select Section Go Contractor Information Contractor Name NHIC, Corp. Contractor Number Contractor Type MAC - Part B Back to Top LCD Information Document Information LCD ID Number L29796 LCD Title Colorectal Cancer Screening Contractor's Determination Number AMA CPT/ADA CDT Copyright Statement CPT only copyright American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association. Applicable Primary Geographic Jurisdiction Vermont Oversight Region Region I Original Determination Effective Date For services performed on or after 05/15/2009 Original Determination Ending Date

2 Page 2 of 15 FARS/DFARS Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. The Code on Dental Procedures and Nomenclature (Code) is published in Current Dental Terminology (CDT). Copyright American Dental Association. All rights reserved. CDT and CDT-2010 are trademarks of the American Dental Association. Revision Effective Date For services performed on or after 06/07/2010 Revision Ending Date CMS National Coverage Policy Language quoted from Centers for Medicare and Medicaid Services (CMS). National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in interpretive manuals are not subject to the Local Coverage Determination (LCD) Review Process (42 CFR [b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See Section1869(f)(1)(A)(i) of the Social Security Act. Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources: Title XVIII of the Social Security Act (SSA): Section 1862(a)(1)(A) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member. Section 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim. Section 1834(d) provides frequency limits and payment instructions for colorectal cancer screening tests. Section 1861(pp) of Title XVIII of the Social Security Act defines the term colorectal cancer screening test Code of Federal Regulations: 42 CFR indicates that diagnostic tests may only be ordered by the treating physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements). 42 CFR describes conditions for and limitations on coverage for colorectal cancer screening tests.

3 Page 3 of 15 CMS Publications: CMS Publication ; Medicare Benefit Policy Manual, Chapter 15: Colorectal Cancer Screening CMS Publication , Medicare National Coverage Determinations Manual, Chapter 1: Colorectal Cancer Screening Tests CMS Publication , Medicare Claims Processing Manual, Chapter 7: 80.6 Colorectal Cancer Screening CMS Publication , Medicare Claims Processing Manual, Chapter 18: Colorectal Cancer Screening Indications and Limitations of Coverage and/or Medical Necessity Abstract: This local coverage determination (LCD) represents local instructions for CMS National Coverage Policy. All italicized text is quoted verbatim from CMS Publication , Medicare Claims Processing Manual, Chapter 18, Sections unless otherwise noted. Effective for services furnished on or after January 1, 1998, payment may be made for colorectal cancer screening for the early detection of cancer. For screening colonoscopy services (one of the types of services included in this benefit) prior to July 2001, coverage was limited to high-risk individuals. For services July 1, 2001, and later, screening colonoscopies are covered for individuals not at high risk. The following services are considered colorectal cancer screening services: Fecal-occult blood test, 1-3 simultaneous determinations (guaiac-based); Flexible sigmoidoscopy; Colonoscopy; and, Barium enema Effective for services on or after January 1, 2004, payment may be made for the following colorectal cancer screening service as an alternative for the guaiac-based fecal-occult blood test, 1-3 simultaneous determinations: Fecal-occult blood test, immunoassay, 1-3 simultaneous determinations (See CMS Publication , Medicare Claims Processing Manual, Chapter 18, Section 60) Indications and Limitations: G Colorectal Cancer Screening; Flexible Sigmoidoscopy Screening flexible sigmoidoscopies (code G0104) may be paid for beneficiaries

4 Page 4 of 15 who have attained age 50, when performed by a doctor of medicine or osteopathy at the frequencies noted below. For claims with dates of service on or after January 1, 2002, contractors or carriers pay for screening flexible sigmoidoscopies (code G0104) for beneficiaries who have attained age 50 when these services were performed by a doctor of medicine or osteopathy, or by a physician assistant, nurse practitioner, or clinical nurse specialist (as defined in 1861(aa) (5) of the Act and in the Code of Federal Regulations at 42 CFR , , and ) at the frequencies noted. For claims with dates of service prior to January 1, 2002, contractors pay for these services under the conditions noted only when a doctor of medicine or osteopathy performs them. For services furnished from January 1, 1998, through June 30, 2001, inclusive: Once every 48 months (i.e., at least 47 months have passed following the month in which the last covered screening flexible sigmoidoscopy was done) For services furnished on or after July 1, 2001: Once every 48 months as calculated above unless the beneficiary does not meet the criteria for high risk of developing colorectal cancer and he/she has had a screening colonoscopy (code G0121) within the preceding 10 years. If such a beneficiary has had a screening colonoscopy within the preceding 10 years, then he or she can have covered a screening flexible sigmoidoscopy only after at least 119 months have passed following the month that he/she received the screening colonoscopy (code G0121). NOTE: If during the course of a screening flexible sigmoidoscopy a lesion or growth is detected which results in a biopsy or removal of the growth; the appropriate diagnostic procedure classified as a flexible sigmoidoscopy with biopsy or removal should be billed and paid rather than code G0104. G Colorectal Cancer Screening; Colonoscopy on Individual at High Risk Screening colonoscopies (code G0105) may be paid when performed by a doctor of medicine or osteopathy at a frequency of once every 24 months for beneficiaries at high risk for developing colorectal cancer (i.e., at least 23 months have passed following the month in which the last covered G0105 screening colonoscopy was performed). Characteristics of the High Risk Individual: An individual at high risk for developing colorectal cancer has one or more of the following: A close relative (sibling, parent, or child) who has had colorectal cancer or an adenomatous polyp; A family history of familial adenomatous polyposis; A family history of hereditary nonpolyposis colorectal cancer; A personal history of adenomatous polyps; A personal history of colorectal cancer; or

5 Page 5 of 15 Inflammatory bowel disease, including Crohn s Disease, and ulcerative colitis. Section 60.3) NOTE: If during the course of the screening colonoscopy, a lesion or growth is detected which results in a biopsy or removal of the growth, the appropriate diagnostic procedure classified as a colonoscopy with biopsy or removal should be billed and paid rather than code G0105. (CMS Publication , Medicare Claims Processing Manual, Chapter 18, When a covered colonoscopy is attempted but cannot be completed because of extenuating circumstances, Medicare will pay for the interrupted colonoscopy as long as the coverage conditions are met for the incomplete procedure. (See CMS Publication , Medicare Claims Processing Manual, Chapter 18, Section 60.2 (A)(1) for additional information.) G Colorectal Cancer Screening; Barium Enema; as an Alternative to G0104, Screening Sigmoidoscopy Screening barium enema examinations may be paid as an alternative to a screening sigmoidoscopy (code G0104). The same frequency parameters for screening sigmoidoscopies (see those codes above) apply. In the case of an individual aged 50 or over, payment may be made for a screening barium enema examination (code G0106) performed after at least 47 months have passed following the month in which the last screening barium enema or screening flexible sigmoidoscopy was performed. For example, the beneficiary received a screening barium enema examination as an alternative to a screening flexible sigmoidoscopy in January Start counts beginning February The beneficiary is eligible for another screening barium enema in January The screening barium enema must be ordered in writing after a determination that the test is the appropriate screening test. Generally, it is expected that this will be a screening double contrast enema unless the individual is unable to withstand such an exam. This means that in the case of a particular individual, the attending physician must determine that the estimated screening potential for the barium enema is equal to or greater than the screening potential that has been estimated for a screening flexible sigmoidoscopy for the same individual. The screening single contrast barium enema also requires a written order from the beneficiary s attending physician in the same manner as described above for the screening double contrast barium enema examination Colorectal Cancer Screening; Fecal-Occult Blood Test, 1-3 Simultaneous Determinations Effective for services furnished on or after January 1, 1998, screening FOBT [fecal-

6 Page 6 of 15 occult blood test] (code 82270) may be paid for beneficiaries who have attained age 50, and at a frequency of once every 12 months (i.e., at least 11 months have passed following the month in which the last covered screening FOBT was performed). This screening FOBT means a guaiac-based test for peroxidase activity, in which the beneficiary completes it by taking samples from two different sites of three consecutive stools. This screening requires a written order from the beneficiary s attending physician. (The term attending physician is defined to mean a doctor of medicine or osteopathy (as defined in 1861(r)(1) of the Act) who is fully knowledgeable about the beneficiary s medical condition, and who would be responsible for using the results of any examination performed in the overall management of the beneficiary s specific medical problem.) Effective for services furnished on or after January 1, 2004, payment may be made for an immunoassay-based FOBT (G0328, described below) as an alternative to the guaiac-based FOBT, Medicare will pay for only one covered FOBT per year, either or G0328, but not both. G Colorectal Cancer Screening; Immunoassay, Fecal-Occult Blood Test, 1-3 Simultaneous Determinations Effective for services furnished on or after January 1, 2004, screening FOBT, (code G0328) may be paid as an alternative to for beneficiaries who have attained age 50. Medicare will pay for a covered FOBT (either or G0328, but not both) at a frequency of once every 12 months (i.e., at least 11 months have passed following the month in which the last covered screening FOBT was performed). Screening FOBT, immunoassay, includes the use of a spatula to collect the appropriate number of samples or the use of a special brush for the collection of samples, as determined by the individual manufacturer s instructions. This screening requires a written order from the beneficiary s attending physician. (The term attending physician is defined to mean a doctor of medicine or osteopathy (as defined in 1861(r)(1) of the Act) who is fully knowledgeable about the beneficiary s medical condition, and who would be responsible for using the results of any examination performed in the overall management of the beneficiary s specific medical problem.) G Colorectal Cancer Screening; Barium Enema; as an Alternative to G0105, Screening Colonoscopy Screening barium enema examinations may be paid as an alternative to a screening colonoscopy (code G0105) examination. The same frequency parameters for screening colonoscopies (see those codes above) apply. In the case of an individual who is at high risk for colorectal cancer, payment may be made for a screening barium enema examination (code G0120) performed after at least 23 months have passed following the month in which the last screening barium enema or the last screening colonoscopy was performed. For example, a beneficiary at high risk for developing colorectal cancer received a screening colonoscopy barium enema examination (code G0120) as an alternative to a

7 Page 7 of 15 screening colonoscopy (code G0105) in January Start counts beginning February The beneficiary is eligible for another screening barium enema examination (code G0120) in January The screening barium enema must be ordered in writing after a determination that the test is the appropriate screening test. Generally, it is expected that this will be a screening double contrast enema unless the individual is unable to withstand such an exam. This means that in the case of a particular individual, the attending physician must determine that the estimated screening potential for the barium enema is equal to or greater than the screening potential that has been estimated for a screening colonoscopy, for the same individual. The screening single contrast barium enema also requires a written order from the beneficiary s attending physician in the same manner as described above for the screening double contrast barium enema examination. G Colorectal Screening; Colonoscopy on Individual Not Meeting Criteria for High Risk - Applicable On and After July 1, 2001 Effective for services furnished on or after July 1, 2001, screening colonoscopies (code G0121) performed on individuals not meeting the criteria for being at high risk for developing colorectal cancer may be paid under the following conditions: At a frequency of once every 10 years (i.e., at least 119 months have passed following the month in which the last covered G0121 screening colonoscopy was performed.) If the individual would otherwise qualify to have covered a G0121 screening colonoscopy based on the above but has had a covered screening flexible sigmoidoscopy (code G0104), then the individual may have covered a G0121 screening colonoscopy only after at least 47 months have passed following the month in which the last covered G0104 flexible sigmoidoscopy was performed. NOTE: If during the course of the screening colonoscopy, a lesion or growth is detected which results in a biopsy or removal of the growth, the appropriate diagnostic procedure classified as a colonoscopy with biopsy or removal should be billed and paid rather than code G0121 Back to Top Coding Information Bill Type Codes: Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee

8 Page 8 of 15 that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims. 013x 014x 022x 023x 085x Hospital Outpatient Hospital - Laboratory Services Provided to Non-patients Skilled Nursing - Inpatient (Medicare Part B only) Skilled Nursing - Outpatient Critical Access Hospital Revenue Codes: Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes. Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes. Revenue codes only apply to providers who bill these services to the fiscal intermediary or Part A MAC. Revenue codes do not apply to physicians, other professionals and suppliers who bill these services to the carrier or Part B MAC. Please note that not all revenue codes apply to every type of bill code. Providers are encouraged to refer to the FISS revenue code file for allowable bill types. Similarly, not all revenue codes apply to each CPT/HCPCS code. Providers are encouraged to refer to the FISS HCPCS file for allowable revenue codes. Revenue codes 096X, 097X and 098X are to be used only by Critical Access Hospitals (CAHs) choosing the optional payment method (also called Option 2 or Method 2) and only for services performed by physicians or practitioners who have reassigned their billing rights. When a CAH has selected the optional payment method, physicians or other practitioners providing professional services at the CAH may elect to bill their carrier or assign their billing rights to the CAH. When professional services are reassigned to the CAH, the CAH must bill the FI using revenue codes 096X, 097X or 098X. 030X Laboratory - General Classification

9 Page 9 of X 036X 049X Radiology - Diagnostic - General Classification Operating Room Services - General Classification Ambulatory Surgical Care - General Classification 0519 Clinic - Other Clinic 0750 Gastro-Intestinal (GI) Services - General Classification 076X Specialty Services - General Classification 0960 Professional Fees - General Classification 0969 Professional Fees - Other Professional Fee 0972 Professional Fees - Radiology - Diagnostic 0982 Professional Fees - Outpatient Services 0983 Professional Fees - Clinic CPT/HCPCS Codes G0104 G0105 G0106 G0120 G0121 G0122 G0328 BLOOD, OCCULT, BY PEROXIDASE ACTIVITY (EG, GUAIAC), QUALITATIVE; FECES, CONSECUTIVE COLLECTED SPECIMENS WITH SINGLE DETERMINATION, FOR COLORECTAL NEOPLASM SCREENING (IE, PATIENT WAS PROVIDED 3 CARDS OR SINGLE TRIPLE CARD FOR CONSECUTIVE COLLECTION) COLORECTAL CANCER SCREENING; FLEXIBLE SIGMOIDOSCOPY COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK COLORECTAL CANCER SCREENING; ALTERNATIVE TO G0104, SCREENING SIGMOIDOSCOPY, BARIUM ENEMA COLORECTAL CANCER SCREENING; ALTERNATIVE TO G0105, SCREENING COLONOSCOPY, BARIUM ENEMA. COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK COLORECTAL CANCER SCREENING; BARIUM ENEMA COLORECTAL CANCER SCREENING; FECAL OCCULT BLOOD TEST, IMMUNOASSAY, 1-3 SIMULTANEOUS

10 Page 10 of 15 ICD-9 Codes that Support Medical Necessity It is the responsibility of the provider to code to the highest level specified in the ICD-9- CM (e.g., to the fourth or fifth digit). The correct use of an ICD-9-CM code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in this determination. Routine screening examinations: V76.41 SCREENING FOR MALIGNANT NEOPLASMS OF THE RECTUM V76.51 SPECIAL SCREENING FOR MALIGNANT NEOPLASMS COLON Screening examinations for persons at high risk: (HCPCS Codes G0105 and G0120) Personal or family history of gastrointestinal neoplasia: BENIGN NEOPLASM OF COLON BENIGN NEOPLASM OF RECTUM AND ANAL CANAL V10.00 V10.05* V10.06* NEOPLASM OF UNCERTAIN BEHAVIOR OF STOMACH INTESTINES AND RECTUM PERSONAL HISTORY OF MALIGNANT NEOPLASM OF UNSPECIFIED SITE IN GASTROINTESTINAL TRACT PERSONAL HISTORY OF MALIGNANT NEOPLASM OF LARGE INTESTINE PERSONAL HISTORY OF MALIGNANT NEOPLASM OF RECTUM RECTOSIGMOID JUNCTION AND ANUS V10.07 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF LIVER V12.72 PERSONAL HISTORY OF COLONIC POLYPS V12.79 PERSONAL HISTORY OF OTHER SPECIFIED DIGESTIVE SYSTEM DISEASES V16.0 FAMILY HISTORY OF MALIGNANT NEOPLASM OF GASTROINTESTINAL TRACT V18.51 FAMILY HISTORY, COLONIC POLYPS * Diagnosis codes included on the Partial List of ICD-9-CM Codes Indicating High Risk (CMS Publication , Medicare Claims Processing Manual, Chapter 18, Section 60.3). Chronic Digestive Disease Condition: 555.0* REGIONAL ENTERITIS OF SMALL INTESTINE

11 Page 11 of * REGIONAL ENTERITIS OF LARGE INTESTINE 555.2* REGIONAL ENTERITIS OF SMALL INTESTINE WITH LARGE INTESTINE 555.9* REGIONAL ENTERITIS OF UNSPECIFIED SITE 556.0* ULCERATIVE (CHRONIC) ENTEROCOLITIS 556.1* ULCERATIVE (CHRONIC) ILEOCOLITIS 556.2* ULCERATIVE (CHRONIC) PROCTITIS 556.3* ULCERATIVE (CHRONIC) PROCTOSIGMOIDITIS PSEUDOPOLYPOSIS OF COLON LEFT-SIDED ULCERATIVE (CHRONIC) COLITIS UNIVERSAL ULCERATIVE (CHRONIC) COLITIS 556.8* OTHER ULCERATIVE COLITIS 556.9* ULCERATIVE COLITIS UNSPECIFIED * Diagnosis codes included on the Partial List of ICD-9-CM Codes Indicating High Risk (CMS Publication , Medicare Claims Processing Manual, Chapter 18, Section 60.3). Inflammatory Bowel: GASTROENTERITIS AND COLITIS DUE TO RADIATION 558.2* TOXIC GASTROENTERITIS AND COLITIS ALLERGIC GASTROENTERITIS AND COLITIS 558.9* OTHER AND UNSPECIFIED NONINFECTIOUS GASTROENTERITIS AND COLITIS * Diagnosis codes included on the Partial List of ICD-9-CM Codes Indicating High Risk (CMS Publication , Medicare Claims Processing Manual, Chapter 18, Section 60.3). Diagnoses that Support Medical Necessity Not applicable ICD-9 Codes that DO NOT Support Medical Necessity Not applicable ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation

12 Page 12 of 15 Diagnoses that DO NOT Support Medical Necessity Not applicable Back to Top General Information Documentations Requirements The patient's medical record must contain documentation that fully supports the medical necessity for services included within this LCD. (See "Indications and Limitations of Coverage."). This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures. Appendices Not applicable Utilization Guidelines Frequency limits for colorectal screening examinations are determined by CMS national policy. Although fecal occult blood screening (HCPCS codes and G0328) is allowed annually, the frequency for all other examinations depends on whether the individual is or is not considered at high risk for colorectal cancer. Sources of Information and Basis for Decision CMS Program Manuals - This policy is based upon CMS National Coverage Policy. Please refer to CMS National Coverage Policy. Advisory Committee Meeting Notes Start Date of Comment Period 02/22/2010 End Date of Comment Period 04/07/2010 Start Date of Notice Period 04/23/2010 Revision History Number R6 Revision History Explanation R6 05/12/2011 Annual review with no changes R5 06/07/2010 The policy has been through the Contractor Advisory Committee process and is effective for J14 MAC, Parts A and B for services rendered on or after 6/7/2010. R4 02/22/2010 Added J14 Part B Contractor numbers 14102, 14202, 14302, 14402,

13 Page 13 of 15 R3 06/05/2009-In accordance with Section 911 of the Medicare Modernization Act of 2003, J14 contractor numbers NH and VT were added. Prior to 06/05/2009 this policy was National Government Services (NGS) Part A LCD #L26402). No coverage changes were made. Only references to NGS were removed. R2 06/01/2009- In accordance with Section 911 of the Medicare Modernization Act of 2003, J14 MAC-Part A Contractor number (formerly Part A Pinnacle ) was added to this LCD. R1 05/15/2009 In accordance with Section 911 of the Medicare Modernization Act of 2003, J14 contractor numbers ME and MA were added. Prior to 05/15/2009 this policy was National Government Services (NGS) Part A LCD #L26402). No coverage changes were made. Only references to NGS were removed. 8/10/ The description for Revenue code 0760 was changed 8/10/ The description for Revenue code 0761 was changed 8/10/ The description for Revenue code 0762 was changed 8/10/ The description for Revenue code 0769 was changed 8/1/ The description for Bill Type Code 13 was changed 8/1/ The description for Bill Type Code 14 was changed 8/1/ The description for Bill Type Code 22 was changed 8/1/ The description for Bill Type Code 23 was changed 8/1/ The description for Bill Type Code 85 was changed 8/1/ The description for Revenue code 0300 was changed 8/1/ The description for Revenue code 0301 was changed 8/1/ The description for Revenue code 0302 was changed 8/1/ The description for Revenue code 0303 was changed 8/1/ The description for Revenue code 0304 was changed 8/1/ The description for Revenue code 0305 was changed 8/1/ The description for Revenue code 0306 was changed 8/1/ The description for Revenue code 0307 was changed 8/1/ The description for Revenue code 0309 was changed 8/1/ The description for Revenue code 0320 was changed 8/1/ The description for Revenue code 0321 was changed 8/1/ The description for Revenue code 0322 was changed 8/1/ The description for Revenue code 0323 was changed 8/1/ The description for Revenue code 0324 was changed 8/1/ The description for Revenue code 0329 was changed 8/1/ The description for Revenue code 0360 was changed 8/1/ The description for Revenue code 0361 was changed 8/1/ The description for Revenue code 0362 was changed 8/1/ The description for Revenue code 0367 was changed 8/1/ The description for Revenue code 0369 was changed 8/1/ The description for Revenue code 0490 was changed

14 Page 14 of 15 8/1/ The description for Revenue code 0499 was changed 8/1/ The description for Revenue code 0519 was changed 8/1/ The description for Revenue code 0750 was changed 8/1/ The description for Revenue code 0760 was changed 8/1/ The description for Revenue code 0761 was changed 8/1/ The description for Revenue code 0762 was changed 8/1/ The description for Revenue code 0769 was changed 8/1/ The description for Revenue code 0960 was changed 8/1/ The description for Revenue code 0969 was changed 8/1/ The description for Revenue code 0972 was changed 8/1/ The description for Revenue code 0982 was changed 8/1/ The description for Revenue code 0983 was changed 8/1/ Revenue code 0759 was deleted 11/21/ For the following CPT/HCPCS codes either the short description and/or the long description was changed. Depending on which description is used in this LCD, there may not be any change in how the code displays in the document: descriptor was changed in Group 1 Reason for Change Other Related Documents This LCD has no Related Documents. LCD Attachments There are no attachments for this LCD. Back to Top All Versions Updated on 05/12/2011 with effective dates 06/07/ N/A Updated on 11/21/2010 with effective dates 06/07/ N/A Updated on 09/03/2010 with effective dates 06/07/ N/A Updated on 08/01/2010 with effective dates 06/07/ N/A Updated on 04/09/2010 with effective dates 06/07/ N/A Some older versions have been archived. Please visit the MCD Archive Site to retrieve them. Read the LCD Disclaimer Back to Top Department of Health & Human Services Medicare.gov USA.gov Web Policies & Important Links Privacy Policy Freedom of Information Act No Fear Act

15 Page 15 of 15 Centers for Medicare & Medicaid Services, 7500 Security Boulevard Baltimore, MD