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Local Coverage Analysis Part B
ID Title Effective Date Revision Effective Date End Date Last Approval / Revision Date
A420322006 Add-On and ZZZ Procedure Codes Additions/Revisions 9/28/2006N/AN/A 9/24/2006
A440092007 Therapy Codes that also Qualify for an Automatic Exception to the Therapy Cap 4/12/2007N/AN/A 4/8/2007
A45783Adjustment of Gastric Band after Bariatric Surgery 8/16/2007 8/16/2007N/A 11/10/2007
A41589Adult Liver Transplantation 9/28/2006N/AN/A 9/24/2006
A25734Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy 2/15/2005 2/15/2005N/A 11/7/2006
A42025Allergy Testing Utilization Reminders 9/28/2006N/AN/A 9/24/2006
A38945Ambulatory Surgery Center (ASC) Billing of Prosthetic Implants (L8699) 3/23/2006 3/23/2006N/A 11/7/2006
A43126Antigen Preparation Billing Clarification 1/11/2006 1/1/2007N/A 7/5/2007
A42750Appropriate billing of INR testing by Independent Diagnostic Testing Facilities 10/26/2006 10/26/2006N/A 1/28/2007
A41762Bexxar Coverage and Coding 9/28/2006N/AN/A 9/24/2006
A45277Billing of Add-on Services for Positron Emission Tomography (PET) Imaging (Non-covered) 5/7/2007N/AN/A 6/5/2007
A35482Cardiac Stress Testing 9/29/2005 9/29/2005N/A 11/7/2006
A35624Cardiovascular Nuclear Medicine 9/29/2005 1/1/2006N/A 11/10/2007
A41761Care Plan Oversight and HHA/Hospice Certification/Recertification Billing Reminder 9/28/2006N/AN/A 9/24/2006
A43119Chemosensitivity (Resistance) Testing - Coding and Billing 2/19/2007 2/19/2007N/A 11/14/2007
A41552Clarification Regarding Effective Dates for Carrier Claim Adjustments: Denied Replacement Defibrillator Claims Lacking a QR Modifier 9/5/2006N/AN/A 9/24/2006
A43166Coding and Billing of Electrodiagnostic Studies 2/19/2006 2/19/2006N/A 2/23/2007
A42578Coding for Stripping Keratoplasty Procedures 10/19/2006N/AN/A 10/15/2006
A46150Coding For Transfer Factor 12/13/2007N/AN/A 12/9/2007
A38614Coding Guidelines for Oncotype DX 3/2/2006 3/2/2006N/A 11/8/2006
A38591Coding Guidelines When Infused Drugs are not on Fee Schedule 2/23/2006 2/23/2006N/A 11/8/2006
A44067Coding Tips - Immunohistochemistry using CPT codes 88342, 88360, and 88361 4/19/2007 4/19/2007N/A 4/16/2007
A35700Comparative Billing Report (CBR) 9/22/2005 9/22/2005N/A 8/31/2007
A42028Comparative Billing Report 2006 - Specialty 11 (Internal Medicine) 9/28/2006 9/28/2006N/A 8/31/2007
A42027Comparative Billing Report 2006- Specialty 08 (Family Practice) 9/28/2006 9/28/2007N/A 8/31/2007
A42023Comparative Billing Report - Nerve Conduction Studies in California, 2006 9/28/2006 9/28/2006N/A 10/1/2006
A42022Comparative Billing Report 2006 - Specialty 01 (General Practice) 9/28/2006 9/28/2006N/A 8/31/2007
A42029Comparative Billing Report 2006 - Specialty 47 (Independent Diagnostic Testing Facility [IDTF]) 9/28/2006 9/28/2006N/A 8/31/2007
A41763Comprehensive Error Rate Testing (CERT) Request for Medical Records 9/28/2006N/AN/A 9/24/2006
A41764Contigen/Durasphere Implant (51715) – Diagnostic Criteria 9/28/2006N/AN/A 9/24/2006
A46313Correct Physician Coding for NDO Plicator Technology (C9724 / CPT 43999) 1/17/2008N/AN/A 1/12/2008
A44008Correction to Draft LCD on Tendon/Ligament Injections 4/12/2007N/AN/A 4/8/2007
A37613Coverage limitations for spinal therapies (VAX-D, DRS system, DRX9000, MEDX, Spina System) 11/24/2005 11/24/2005N/A 11/7/2006
A25575CT Colonography (Virtual Colonoscopy) 1/1/2005 1/1/2005N/A 11/7/2006
A38655Date of Service for Molecular Tests on Tissue Specimens 3/2/2006 3/2/2006N/A 11/8/2006
A25296Diabetes Mellitus Therapy Using Hepatic Activation or PIVIT Therapy 6/16/2005 1/1/2006N/A 11/10/2007
A42579Direct Measurement of LDL (CPT Code 83721) 10/19/2006N/AN/A 10/15/2006
A44066Documentation Tips - Pathology Consultations 4/19/2007N/AN/A 4/13/2007
A25217Echocardiography, Transthoracic and Transesophageal 6/16/2005 6/16/2005N/A 11/8/2006
A25301Electrocardiograms 9/15/2005N/AN/A 9/11/2005
A41906Electrodiagnostic Testing Requirements 9/28/2006N/AN/A 9/24/2006
A41550Electronic Analyses of Implantable Cardioverter-defibrillators and Pacemakers 7/10/2006N/AN/A 9/24/2006
A45517Erythropoietin Stimulating Agents (ESAs) - Billing Guidelines 1/1/2007 1/1/2007N/A 7/11/2007
A41765Finger and Toe Modifiers 9/28/2006N/AN/A 9/24/2006
A43950Flow Cytometry - Billing Guidelines 1/1/2007N/AN/A 4/8/2007
A39517Guidelines for Extracorporeal Shock Wave Therapy (ESWT) for Treatment of Plantar Fasciitis 5/25/2006 5/25/2006N/A 11/7/2006
A25828Implantable Infusion Pump for Treatment of Chronic Intractable Pain 1/1/2004 1/1/2004N/A 11/10/2007
A41907Independent Diagnostic Testing Facilities (IDTFs) - Reminders 9/28/2006N/AN/A 9/24/2006
A26346Independent Diagnostic Testing Facilities - Supervision and Medical Responsibility Requirements 3/24/2005 3/24/2005N/A 11/7/2006
A43165Insertion of X Stop Device for Back Pain 1/18/2007 1/18/2007N/A 11/10/2007
A41903Internet Access and Analysis of Implantable Cardioverter Defibrillator Data – Correction 9/28/2006N/AN/A 9/24/2006
A43989Intraoperative Monitoring (CPT Code 95920) 4/5/2007N/AN/A 4/1/2007
A43169Intravenous Immune Globulin (IVIg) Billing Information 1/2/2007 7/1/2007N/A 7/16/2007
A42383Intravenous Iron Therapy in Non-dialysis Patients 10/5/2006 10/5/2006N/A 11/8/2006
A41556Laboratory Competitive Bidding Demonstration 9/28/2006N/AN/A 9/24/2006
A41557Lumbar Artificial Disc Replacement 5/16/2006 5/16/2006N/A 11/8/2006
A25577Macugen® Treatment of Wet Age-Related Macular Degeneration - Revision 1 2/10/2005 1/1/2006N/A 11/7/2006
A46315Medical Review Post Payment Service Specific Widespread Probe Results for Colonoscopy 1/17/2008N/AN/A 1/13/2008
A46316Medical Review Post Payment Service Specific Widespread Probe Results for Therapeutic Activities 1/17/2008N/AN/A 1/13/2008
A42627Method of Denial for Cosmetic Surgery 11/1/2006 11/1/2006N/A 1/28/2007
A42030Modifier 55: Postoperative Care Management Only –Billing Reminders 9/28/2006N/AN/A 9/24/2006
A41555Modifier Update for Islet Cell Transplantation in National Institutes of Health (NIH) Clinical Trials 5/1/2006N/AN/A 9/24/2006
A42024Nerve Conduction Studies 9/28/2006N/AN/A 9/24/2006
A38730NHIC, Corp. Enrollment of Providers Contingent on California Regulations 3/9/2006 3/9/2006N/A 11/7/2006
A43190Optometrists (Specialty 41) - Payable Services within the Scope of Practice, State of California 1/1/2007N/AN/A 1/14/2007
A41558Pancreas Transplants Alone 4/26/2006N/AN/A 9/24/2006
A41551Payment for Carotid Artery Stenting Post Approval Extension Studies 2/28/2006N/AN/A 9/24/2006
A41767Percutaneous Transluminal Angioplasty of the Carotid Artery with Stent Placement 9/28/2006N/AN/A 9/24/2006
A25001Pharmacologic Management 9/28/2006 9/28/2006N/A 11/8/2006
A38699Physician Assistants (PA) Guidance for Medicare Part B California 3/9/2006 3/9/2006N/A 11/8/2006
A41904Physician's Certification and Recertification of Need for Treatment and Therapy Plans of Care for Outpatient Physical Therapy and Occupational Therapy 9/28/2006N/AN/A 9/24/2006
A33859Positron Emission Tomography (PET) Scans 1/28/2005 1/28/2005N/A 11/10/2007
A36711Progressive Corrective Action - Chiropractic Referrals 10/27/2005 10/27/2005N/A 11/7/2006
A36713Progressive Corrective Action - Documentation not Substantiating Extension of Physical Therapy Services 10/27/2005 10/27/2005N/A 11/7/2006
A41900Progressive Corrective Action - Evaluation and Management Services 9/28/2006 9/28/2006N/A 11/8/2006
A42031Prolonged Physician Services (With Direct Face-to-Face Contact) 9/28/2006N/AN/A 9/24/2006
A41553Provider Enrollment – New Enrollment and Update Changes 7/1/2006 7/1/2006N/A 11/8/2006
A43333Removal of Impacted Cerumen (CPT 69210) – Coding and Billing Guidance 2/15/2007N/AN/A 2/9/2007
A45873Repeat Microvolt T-wave Alternans Testing 9/27/2007N/AN/A 9/23/2007
A43332Restrictions on Additional Payment For Use of Operating Microscope 2/15/2007N/AN/A 2/9/2007
A33651Robotic Arm in Cardiac/Vascular Surgery 5/12/2005 5/12/2005N/A 11/7/2006
A46314Routine Billing of Blood Glucose Labs by Institutions or Home Health 1/17/2008N/AN/A 1/12/2008
A20472Routine Foot Care 6/24/2004 7/15/2004N/A 11/10/2007
A41905Rural Health Center Services Billing 9/28/2006N/AN/A 9/24/2006
A43162Self-Administered Drugs Exclusion List 2007 1/1/2007N/AN/A 11/10/2007
A45856Status of Services Which Support Non-covered Services or Devices 8/30/2007N/AN/A 8/26/2007
A43158Teleradiology - How to Bill Medicare 1/11/2007N/AN/A 1/7/2007
A37611Temporomandibular Joint Disorders (TMD)/Splint Fabrication and Fitting 12/1/2005 12/1/2005N/A 11/7/2006
A20659Therapeutic Infusions Associated with Chemotherapy - Revision 1 6/4/2004 1/1/2006N/A 11/10/2007
A45784Trofile Test for Maraviroc Therapy – Coding Guidance 8/24/2007N/AN/A 8/16/2007
A37301Wastage of Drugs in “Single-Use Vials” 3/30/2006 3/30/2006N/A 11/7/2006
A41901Weekly Radiation Therapy Management 9/28/2006N/AN/A 9/24/2006
A39115When Clinics Must Enroll as Independent Diagnostic Testing Facilities (IDTFs) 3/30/2006 3/30/2006N/A 11/7/2006
A41021When Home Health Agency Billing for 82962 is not Appropriate 8/10/2006 8/10/2006N/A 11/7/2006
A45893When Outpatient Lab Tests Should be Billed to Part B 9/20/2007N/AN/A 9/16/2007
A41902Wireless Capsule Endoscopy 9/28/2006N/AN/A 9/24/2006
A45209X-Rays and Electrocardiograms (ECGs or EKGs) Provided in the Hospital Emergency Room 6/7/2007N/AN/A 5/31/2007
A24592Xeloda (capecitabine) in lieu of 5-FU for cancer therapy 12/10/2004 12/10/2004N/A 11/7/2006


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