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Coding Analysis for Labs (CAL) Tracking Sheet

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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Issue

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.

National Coverage Determinations

Benefit Category

Diagnostic Tests (other)

Requestor Information

Requestor Name Requestor Letter
Internally Generated N/A
N/A

Important Dates

Formal Request Accepted and Review Initiated
08/09/2005
Expected CAL Completion Date
01/01/2006
Public Comment Period
08/09/2005 - 09/09/2005
Proposed Decision Memo Due Date
11/06/2005
Proposed Decision Memo Released
Proposed Decision Memo Public Comment Period
Decision Memo Released
10/03/2005
Comments for this CAL
View Public Comments

Contacts

Lead Analysts
Jackie Sheridan-Moore
Lead Medical Officers

Medicare Benefit Category Determination Date

Actions Taken

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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