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Coding Analysis for Labs (CAL) Tracking Sheet for Codes That Are Not Covered by Medicare (Removal of ICD-9-CM Code V76.44, Prostate Cancer Screening, From the List) (CAG-00297N)


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At the time Medicare developed the national coverage determinations (NCDs) for clinical diagnostic laboratory services under the negotiated rulemaking authority, Medicare did not have a prostate cancer screening benefit. Consequently, we included ICD-9-CM code V76.44, Special screening for malignant neoplasms of the prostate, on the list of codes that are not covered by Medicare along with numerous other screening services.

Subsequently, the Medicare statute was amended to add prostate cancer screening as a covered Medicare benefit. In implementing this new statutory benefit, we neglected to remove the code for prostate screening from the list of codes that are not covered by Medicare. We are proposing to remove it now and are seeking public input on this matter.
Diagnostic Tests (other)
Requestor Name(s):  Internally Generated
Formal Request Accepted and Review Initiated:  08/09/2005
Expected NCA Completion Date:  01/01/2006
Public Comment Period:  08/09/2005 - 09/09/2005
Proposed Decision Memo Due Date:  11/06/2005
Decision Memo Released:  10/03/2005
Comments for this CAL::  View Public Comments
Lead Analyst(s): 
  • Jackie Sheridan-Moore
August 9, 2005 CMS opens a Coding Analysis issue on screening prostate as a non-covered diagnosis. CMS is requesting public comment before any changes are made to the list of non-covered codes. After considering the public comments, we will release a proposed decision memorandum.
October 3, 2005 CMS posts a decision memorandum  outlining its intent to remove ICD-9-CM code V76.44 from the list of “ICD-9-CM Codes Denied” and to also add V76.44 to the list of codes that do not support medical necessity for blood counts in the negotiated laboratory NCDs.
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