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Local Coverage Analysis Part A
ID Title Effective Date Revision Effective Date End Date Last Approval / Revision Date
A15366"Ambulance: Physician's Certification" Who can Sign? 11/4/2003 11/4/2003N/A 11/24/2003
A21116"Mapping" Facility Levels for Hospital Clinic E/M 6/17/2004 6/17/2004N/A 8/2/2004
A15146· 32403 - The revenue code requires a HCPC, however the HCPC indicated is not valid 9/11/2003 9/11/2003N/A 10/23/2003
A257142005 Update for Coding and Payment for Drug Administration 1/31/2005N/AN/A 2/15/2005
A387152006 Brings New Drug Administration Codes 2/28/2006N/AN/A 3/1/2006
A397853-D Reconstruction of CT, MRI or other Tomography Modality Images 5/1/2006N/AN/A 5/3/2006
A3775766984 - Extracapsular Cataract Removal with Insertion of Intraocular Lens Prosthesis (one stage procedure), Manual or Mechanical Technique (e.g., irrigation and aspiration or phacoemulsification). 11/30/2005N/AN/A 11/30/2005
A3870669210- Removal Impacted Cerumen (separate procedure), one or both ears 2/28/2006N/AN/A 3/1/2006
A4252571X Type of Bill to Monitor Billing Practices 10/6/2006N/AN/A 10/9/2006
A3818777295- Therapeutic Radiology simulation-aided field settings, three-dimensional 12/28/2005N/AN/A 12/29/2005
A21117Abbreviation Use in Documentation 6/17/2004 6/17/2004N/A 8/2/2004
A33320About Conditon Code 44/Inpatient status to Outpatient. 4/7/2005N/AN/A 4/18/2005
A44949Acid Phosphatase – Supplemental Instructions Article 12/1/2007 12/1/2007N/A 9/20/2007
A11407Activase 7/6/2001 7/6/2001N/A 9/5/2003
A13494Activase 7/5/2000 7/5/2000N/A 9/24/2003
A38209Acute Care: Inpatient, Observation and Treatment Room Services 12/31/2005 12/31/2005N/A 3/29/2006
A21114Additional Development Request (ADR) 6/15/2004 6/15/2004N/A 8/2/2004
A46356Additional Documentation Request (ADR) Tips 1/14/2008N/AN/A 1/16/2008
A11257Additional Hectorol Code 2/20/2001 2/20/2001N/A 9/3/2003
A20847Additional Information Regarding the Proper Billing of the Oral Anti-Cancer Prodrug, Capecitabine 6/28/2004 6/28/2004N/A 7/2/2004
A3394Adult Liver Transplantation 8/15/2001 8/15/2001N/A 6/25/2003
A3481Advance Beneficiary Notices for Part B 8/22/2000 8/22/2000N/A 6/25/2003
A12256Air Ambulance 3/22/2000 3/22/2000N/A 9/13/2003
A25653Albumin on ESRD Claims FAQs 12/7/2004 7/7/2006N/A 8/17/2006
A46754Alteplase Recombinant (e.g., Cathflo® Activase ®) – Related to LCD L25820 3/1/2008N/AN/A 2/21/2008
A37758Ambulance – Billing for an Emergency Response 11/30/2005N/AN/A 11/30/2005
A11267Ambulance Billing 3/29/2001 3/29/2001N/A 9/3/2003
A11263AMBULANCE CERTIFICATION 3/29/2001 3/29/2001N/A 9/3/2003
A16482Ambulance Claims with Modifier QL 11/10/2003 11/10/2003N/A 12/24/2003
A2995Ambulance Claims with Modifier QL or Value Code 32 4/17/2003 4/17/2003N/A 6/13/2003
A39332AMBULANCE SERVICES 3/28/2006N/AN/A 4/3/2006
A43247Ambulance Transport 1/16/2007N/AN/A 3/9/2007
A46358Ambulance Transport 1/14/2008N/AN/A 1/16/2008
A21122Ambulance Updates 6/18/2004 6/18/2004N/A 8/2/2004
A15171Ambulance Zip Codes 8/15/2003 8/15/2003N/A 10/24/2003
A4109Ambulatory Blood Pressure Monitoring 2/13/2002 2/13/2002N/A 6/25/2003
A15368Analysis of CPT codes for Clarification, 67966 and 15260 11/4/2003 11/4/2003N/A 11/24/2003
A11268Ancillary Billing 4/6/2001 4/6/2001N/A 9/3/2003
A46092Apligraf ® – Related to LCD L26003 12/1/2007 3/1/2008N/A 2/6/2008
A11100Appeal Reversals 7/9/2002 7/9/2002N/A 8/29/2003
A11252Appeals Review 1/10/2001 1/10/2001N/A 9/3/2003
A21119Appeals: List all items and services you wish to appeal on your claim. 6/17/2004 6/17/2004N/A 8/2/2004
A22440Application of ICD-9 CM to Support Medical Necessity 8/27/2004 8/27/2004N/A 9/10/2004
A46359Aquatic Therapies 1/14/2008N/AN/A 1/16/2008
A21061Arthroscopic Lavage and Debridement for the Osteoarthritic Knee 7/9/2004 7/9/2004N/A 7/9/2004
A46361Aspirin and PT/PTT 1/14/2008N/AN/A 1/16/2008
A3005Assigning Liability for Line Items Excluded by Statute on Otherwise Covered Claims 5/13/2003 5/5/2003N/A 6/13/2003
A3646Audiologist's Services 5/21/2001 5/21/2001N/A 9/22/2003
A11254Autoadjudicated Denials/ Appeal Requests 1/10/2001 1/10/2001N/A 9/3/2003
A22337Autologous Blood-Derived Products for Chronic, Non-Healing Wounds 8/19/2004 8/19/2004N/A 8/19/2004
A39805Automatic Exceptions from Therapy Cap 5/2/2006 7/11/2006N/A 8/3/2006
A46099Azacitidine (e.g., Vidaza TM) - Related to LCD L25820 12/1/2007N/AN/A 11/21/2007
A19118Bacterial Culture 3/30/2004 3/30/2004N/A 7/2/2006
A11253Beneficiary Appeals for Noncovered Services 1/10/2001 1/10/2001N/A 9/3/2003
A39780BENEPHIT CV INFUSION SYSTEM 5/1/2006N/AN/A 5/3/2006
A46107Beta Glucocerebrosidase (Ceredase®/Cerezyme®) – Related to LCD L25820 12/1/2007N/AN/A 11/21/2007
A46095Bevacizumab (e.g., Avastin TM) - Related to LCD L25820 12/1/2007N/AN/A 11/21/2007
A35127Billing Blood Products 7/25/2005N/AN/A 7/25/2005
A11116Billing Chemotherapy Drug HCPCS Under the Outpatient Prospective Payment System (OPPS) 4/15/2002 4/15/2002N/A 9/2/2003
A25876Billing Dental Claims 2/15/2005N/AN/A 3/2/2005
A8351Billing for Active Wound Procedures 5/15/2003 5/15/2003N/A 1/20/2005
A16273BILLING FOR BARIUM SWALLOW 8/20/2003 8/20/2003N/A 12/10/2003
A14637Billing for Clinical Trials and IDE 10/10/2003 10/10/2003N/A 10/20/2003
A11414Billing for Drugs Under OPPS 7/25/2001 7/25/2001N/A 9/5/2003
A16378BILLING FOR NON-COVERED CHARGES 10/16/2003 10/16/2003N/A 12/18/2003
A16280BILLING FOR NON-COVERED DIAGNOSTICS 9/25/2003 9/25/2003N/A 12/10/2003
A11249Billing for Noncovered Supplies 1/10/2001 1/10/2001N/A 9/3/2003
A11277Billing for the Observation Period and Clarification for Billing of Direct Admit to Observation 10/4/2001 10/4/2001N/A 9/3/2003
A11247Billing for Timed Rehab Codes 1/10/2001 1/10/2001N/A 9/3/2003
A41030Billing of Medications - FAQs 7/24/2006 8/15/2006N/A 8/15/2006
A37180Billing of Medications - FAQs 9/15/2005 7/24/2006N/A 8/17/2006
A4196Billing of multiple surgical procedures performed at same session 5/21/2002 5/21/2002N/A 6/25/2003
A37177Billing of Oxaliplatin - FAQs 10/27/2005 7/12/2006N/A 7/21/2006
A22335Billing Requirements for Islet Cell Transplantation for Beneficiaries in NIH Clinical Trials 8/19/2004 8/19/2004N/A 8/19/2004
A24152Billing Requirements for Positron Emission Tomography (PET) Scans for Dementia and Neurodegenerative Diseases 11/22/2004N/AN/A 11/22/2004
A22849Billing Self-Administered Drugs under the Correct Revenue Code 9/15/2004 9/15/2004N/A 9/28/2004
A33327Billing Unlisted Procedure Codes 4/7/2005N/AN/A 4/18/2005
A4018Biofeedback Training for Treatment of Urinary Incontinence 5/21/2001 5/21/2001N/A 6/25/2003
A45056Biologic Products for Wound Treatment and Surgical Interventions - Supplemental Instructions Article 12/1/2007 12/1/2007N/A 9/21/2007
A44021Blepharoplasty/Blepharoptosis 7/6/2007 7/24/2007N/A 11/10/2007
A44020Blepharoplasty/Blepharoptosis 7/6/2007 7/24/2007N/A 11/10/2007
A11279Blood Administration 10/4/2001 10/4/2001N/A 9/3/2003
A40259Blood Glucose 5/24/2005 7/7/2006N/A 8/17/2006
A38492Blood Glucose Checks 2/3/2006 7/24/2006N/A 8/3/2006
A38491Blood Glucose Monitor 2/3/2006 7/24/2006N/A 8/3/2006
A6278BLOOD GLUCOSE MONITORING 7/7/2003 7/7/2003N/A 7/10/2003
A38495Blood Glucose Results 2/3/2006 7/24/2006N/A 8/3/2006
A37759Blood Glucose Testing 11/30/2005N/AN/A 11/30/2005
A38490Blood Glucose Testing 2/3/2006 7/24/2006N/A 8/3/2006
A45785Blood Glucose Testing 8/1/2007N/AN/A 8/13/2007
A37760Bone Density Measurement 11/30/2005N/AN/A 11/30/2005
A15340Bone Marrow Aspiration /Biopsy Reporting 11/3/2003 11/3/2003N/A 11/24/2003
A45896Bone Mass Measurement - Medical Policy Article 1/1/2007 2/1/2008N/A 2/4/2008
A37873Botulinum Toxin Type A 12/7/2005 12/7/2005N/A 2/18/2008
A16010B-Type Natriuretic Peptide (BNP) -Correctly code for payment 12/2/2003 12/2/2003N/A 12/30/2003
A12251Bulletin 1889 Clarification 3/15/2000 3/15/2000N/A 9/13/2003
A45894Cancer Chemotherapeutic Agents 9/27/2007 10/22/2007N/A 11/21/2007
A45892Cancer Chemotherapeutic Agents 9/27/2007 10/22/2007N/A 11/21/2007
A6302Cardiac and Pulmonary Rehab Supervision 4/23/2003 4/23/2003N/A 9/22/2003
A39294Cardiac Catheterization 6/15/2006N/AN/A 4/26/2006
A45020Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA) - Supplemental Instructions Article 12/1/2007 3/1/2008N/A 2/14/2008
A44455Cardiac Output Measurement Thoracic Electrical Bioimpedance – Supplemental Instructions Article 12/1/2007 1/1/2008N/A 12/20/2007
A17175Cardiac Output Monitoring by Thoracic Electrical Bioimpediance (TEB) 1/26/2004 1/26/2004N/A 1/27/2004
A38635Cardiac Rehab - Coronary Bypass Surgery 2/3/2006 7/24/2006N/A 8/15/2006
A38633Cardiac Rehab - Exercise Program Area 2/3/2006 7/24/2006N/A 8/3/2006
A38631Cardiac Rehab - Physician's Involvement 2/3/2006 7/24/2006N/A 8/3/2006
A12242Cardiac rehab coverage 2/14/2000 2/14/2000N/A 9/22/2003
A12255Cardiac Rehab Physician Supervision 3/22/2000 3/22/2000N/A 9/22/2003
A3011CARDIAC REHABILITATION 5/21/2003 5/21/2003N/A 9/22/2003
A10254CARDIAC REHABILITATION 11/14/2002 11/14/2002N/A 9/22/2003
A40120Cardiac Rehabilitation 4/11/2006 7/24/2006N/A 8/3/2006
A21839Cardiac Rehabilitation Coverage and Billing 8/3/2004 8/3/2004N/A 8/3/2004
A41319CARDIAC REHABILITATION COVERED DIAGNOSES 6/12/2006N/AN/A 8/29/2006
A45888Cardiac Rehabilitation Programs – Medical Policy Article 10/1/2007 2/1/2008N/A 1/24/2008
A24789Cardiovascular Screening Blood Test 1/1/2005N/AN/A 12/27/2004
A46130Cardiovascular Stress Testing 12/20/2007N/AN/A 1/15/2008
A46123Cardiovascular Stress Testing 12/20/2007N/AN/A 1/15/2008
A46075Category III CPT® Code Coverage – LCD Attachment 12/1/2007 1/1/2008N/A 2/18/2008
A44880Category III CPT® Codes – Supplemental Instructions Article 12/1/2007 12/1/2007N/A 2/18/2008
A34194CERT Denials Due to Insufficient Documentation 6/8/2005N/AN/A 6/8/2005
A33322Cert Website 4/7/2005N/AN/A 4/18/2005
A8391Certification and Recertification for Partial Hospitalization Program (PHP) Services 6/6/2003 6/6/2003N/A 6/8/2004
A16421Change in the Process of Re-opening records received between 45 and 60 days of the ADR date 12/22/2003 12/22/2003N/A 12/22/2003
A24084Change in the Type of Bill for Billing Diagnostic and Screening Mammographies 11/17/2004N/AN/A 11/17/2004
A45876Charges for Missed Appointments 8/27/2007N/AN/A 9/11/2007
A3004Claim Adjustment Versus Appeal 5/13/2003 5/13/2003N/A 6/13/2003
A25710Claim Adjustments 1/26/2005N/AN/A 2/15/2005
A11552Claims Containing HCPCS Code G0204 and G0205 12/10/2001 12/10/2001N/A 9/9/2003
A1853Claims Information 3/13/2003 3/13/2003N/A 6/5/2003
A2987Claims Information 4/17/2003 4/17/2003N/A 6/13/2003
A11112Claims Information 4/15/2002 4/15/2002N/A 9/2/2003
A11127Claims Information 3/12/2002 3/12/2002N/A 9/2/2003
A13018Clairification of Liver Transplant Policy 3/30/2000 3/30/2000N/A 9/22/2003
A21102Clarification for Billing Left Ventribular Assist Devices 7/12/2004 7/12/2004N/A 7/12/2004
A39614Clarification for Intensity Modulated Radiation Therapy (IMRT) 4/25/2006N/AN/A 4/25/2006
A36492Clarification for Psychiatric Inpatient Hospitalization 9/27/2005N/AN/A 9/29/2005
A45878Clarification of CPT code 74300 Cholangiography and/or pancreatography; intraoperative, radiological supervision and interpretation 8/27/2007N/AN/A 9/11/2007
A22507Clarification of Epoetin Alfa (EPO) billing procedures and codes in ESRD 9/1/2004 9/1/2004N/A 9/1/2004
A24147Clarification of Epoetin Alfa (EPO) Billing Procedures and Codes in ESRD 11/22/2004N/AN/A 11/22/2004
A24799Clarification of Medicare's Transfer Policy Under PPS 12/29/2004N/AN/A 12/29/2004
A11126Clarification of New Patient Status Codes 62 and 63 3/27/2002 3/27/2002N/A 9/2/2003
A11123Clarification of Payment Responsibilities of Fee-for-Service Contractors as it Relates to Hospice Members Enrolled in Managed Care Organizations (MCOs) and Claims Processing Instructions for Processing Rejected Claims 4/2/2002 4/2/2002N/A 9/2/2003
A6041Clarification of Policy for Billing Injectable Medications (Single and Multiple Dose 2/15/2003 2/15/2003N/A 7/9/2003
A2985Clarification of Policy for Billing Injectable Medications in ESRD Clincs 4/7/2003 4/7/2003N/A 6/12/2003
A45010Clarification of Terminated Multiple Planned Procedures 5/16/2007N/AN/A 5/16/2007
A3114Clarification on 3-Day Window Provisions 5/30/2003 5/30/2003N/A 6/18/2003
A12240Clarification on billing and reimbursement issues concerning disasters 1/10/2000 1/10/2000N/A 9/13/2003
A16504Clarification on End Stage Renal Disease (ESRD) Reimbursement for Automated Multi-Channel Chemistry (AMCC) Tests 11/24/2003 11/24/2003N/A 12/24/2003
A26538Clinical Implications Related to the Inpatient Psychiatric Facility Prospective Payment System 3/18/2005N/AN/A 7/9/2005
A12275Clinical Trials: Clarification on Coverage and Routine Costs - Medical Policy Article 12/3/2001 7/23/2007N/A 10/25/2007
A45019Code J9310 – Rituximab, 100mg 5/16/2007N/AN/A 5/16/2007
A46134Coding Article for Erythropoiesis Stimulating Agents (ESAs): National Benefit 10/1/2007N/AN/A 1/17/2008
A46136Coding Article for Erythropoiesis Stimulating Agents (ESAs): National Benefit 10/1/2007N/AN/A 1/17/2008
A45789Coding Article for Hemophilia Clotting Factors (National Benefit) 9/11/2007N/AN/A 9/10/2007
A45788Coding Article for Hemophilia Clotting Factors (National Benefit) 9/11/2007N/AN/A 9/10/2007
A40769Coding Guidelines For Hyperbaric Oxygen Therapy Corresponds with Draft Local Coverage Determination for Hyperbaric Oxygen Therapy 5/18/2006N/AN/A 6/16/2006
A11153Coding Issues 4/23/2001 4/23/2001N/A 9/2/2003
A33328Coding Update Grace Period Eliminated. 4/7/2005N/AN/A 4/18/2005
A37763Colonoscopy Review Results 11/30/2005N/AN/A 11/30/2005
A39333Colorectal Cancer Screening vs. Occult Blood testing 3/28/2006N/AN/A 4/3/2006
A22847Common Billing Errors for Group and Individual Psychotherapy Claims-Outpatient 9/15/2004 9/15/2004N/A 9/28/2004
A34193Comprehensive Error Rate Testing 6/8/2005N/AN/A 6/8/2005
A23670Comprehensive Outpatient Rehabilitation Facilities 10/22/2004N/AN/A 10/22/2004
A36491Comprehensive Outpatient Rehabilitation Facility 9/27/2005N/AN/A 9/29/2005
A40707Comprehensive Outpatient Rehabilitation Facility (CORF) 6/13/2006N/AN/A 6/15/2006
A16403COMPRESSION DRESSINGS/UNNA BOOT BILLING (HCPCS 29580) 10/16/2003 10/16/2003N/A 12/18/2003
A44376Computed Tomographic (CT) Colonography - Supplemental Instructions Article 12/1/2007 12/1/2007N/A 9/19/2007
A22605Condition Code 59 for ESRD Beneficiaries who rece