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    License Agreements

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    LICENSE FOR USE OF PHYSICIANS’ CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT")


    End User Point and Click Amendment:

    CPT codes, descriptions and other data only are copyright 2020 American Medical Association. American Medical Association. All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the American Medical Association (AMA).

    You, your employees and agents are authorized to use CPT only as contained in the following authorized materials of CMS internally within your organization within the United States for the sole use by yourself, employees and agents. Use is limited to use in Medicare, Medicaid or other programs administered by the Centers for Medicare and Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.

    Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the AMA, CPT Intellectual Property Services, AMA Plaza, 330 Wabash Ave., Suite 39300, Chicago, IL 60611-5885. Applications are available at the AMA Web site, http://www.ama-assn.org/cpt.

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    CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon no upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

    CMS Disclaimer

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    Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by clicking below on the button labeled "I Accept".

    LICENSE FOR USE OF CURRENT DENTAL TERMINOLOGY (CDTTM)


    End User License Agreement:

    These materials contain Current Dental Terminology (CDTTM), copyright © 2020 American Dental Association (ADA). All rights reserved. CDT is a trademark of the ADA.

    The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. By clicking below on the button labeled "I accept", you hereby acknowledge that you have read, understood and agreed to all terms and conditions set forth in this agreement.

    If you do not agree with all terms and conditions set forth herein, click below on the button labeled "I do not accept" and exit from this computer screen.

    If you are acting on behalf of an organization, you represent that you are authorized to act on behalf of such organization and that your acceptance of the terms of this agreement creates a legally enforceable obligation of the organization. As used herein, "you" and "your" refer to you and any organization on behalf of which you are acting.

    1. Subject to the terms and conditions contained in this Agreement, you, your employees and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials.

    2. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT for resale and/or license, transferring copies of CDT to any party not bound by this agreement, creating any modified or derivative work of CDT, or making any commercial use of CDT. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Applications are available at the American Dental Association web site, http://www.ADA.org.

    3. Applicable Federal Acquisition Regulation Clauses (FARS)/Department of Defense Federal Acquisition Regulation supplement (DFARS) Restrictions Apply to Government Use. Please click here to see all U.S. Government Rights Provisions. opens in new window

    4. Organizations who contract with CMS acknowledge that they may have a commercial CDT license with the ADA, and that use of CDT codes as permitted herein for the administration of CMS programs does not extend to any other programs or services the organization may administer and royalties dues for the use of the CDT codes are governed by their commercial license.

    5. ADA DISCLAIMER OF WARRANTIES AND LIABILITIES. CDT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CDT. The ADA does not directly or indirectly practice medicine or dispense dental services. The sole responsibility for software, including any CDT and other content contained therein, is with CMS; and no endorsement by the ADA is intended or implied. The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice to you if you violate the terms of this Agreement.

      The ADA is a third party beneficiary to this Agreement.

    6. CMS DISCLAIMER. The scope of this license is determined by the ADA, the copyright holder. Any questions pertaining to the license or use of the CDT should be addressed to the ADA. End Users do not act for or on behalf of the CMS. CMS disclaims responsibility for any liability attributable to end user use of the CDT. CMS will not be liable for any claims attributable to any errors, omissions, or other inaccuracies in the information or material covered by this license. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

      The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. If the foregoing terms and conditions are acceptable to you, please indicate your agreement by clicking below on the button labeled "I Accept". If you do not agree to the terms and conditions, you may not access or use software. Instead you must click below on the button labeled "I Do Not Accept" and exit from this computer screen.

    LICENSE FOR NATIONAL UNIFORM BILLING COMMITTEE (NUBC)


    American Hospital Association Disclaimer


    The American Hospital Association ("the AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.


    The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. If the foregoing terms and conditions are acceptable to you, please indicate your agreement by clicking below on the button labeled "I Accept". If you do not agree to the terms and conditions, you may not access or use the software. Instead, you must click below on the button labeled "I Do Not Accept" and exit from this computer screen.

    Local Coverage Determination (LCD):
    Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma (L34076)


    Alert: Codes have moved from LCDs to Articles! Learn more opens in new window

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    • Expand All All sections on the page are Expanded
    • Collapse All All sections on the page are Collapsed

    Expand/Collapse the Contractor Information section Contractor Information

    Contractor NameContract TypeContract NumberJurisdictionState(s)
    Noridian Healthcare Solutions, LLC A and B MAC02101 - MAC AJ - FAlaska
    Noridian Healthcare Solutions, LLC A and B MAC02102 - MAC BJ - FAlaska
    Noridian Healthcare Solutions, LLC A and B MAC02201 - MAC AJ - FIdaho
    Noridian Healthcare Solutions, LLC A and B MAC02202 - MAC BJ - FIdaho
    Noridian Healthcare Solutions, LLC A and B MAC02301 - MAC AJ - FOregon
    Noridian Healthcare Solutions, LLC A and B MAC02302 - MAC BJ - FOregon
    Noridian Healthcare Solutions, LLC A and B MAC02401 - MAC AJ - FWashington
    Noridian Healthcare Solutions, LLC A and B MAC02402 - MAC BJ - FWashington
    Noridian Healthcare Solutions, LLC A and B MAC03101 - MAC AJ - FArizona
    Noridian Healthcare Solutions, LLC A and B MAC03102 - MAC BJ - FArizona
    Noridian Healthcare Solutions, LLC A and B MAC03201 - MAC AJ - FMontana
    Noridian Healthcare Solutions, LLC A and B MAC03202 - MAC BJ - FMontana
    Noridian Healthcare Solutions, LLC A and B MAC03301 - MAC AJ - FNorth Dakota
    Noridian Healthcare Solutions, LLC A and B MAC03302 - MAC BJ - FNorth Dakota
    Noridian Healthcare Solutions, LLC A and B MAC03401 - MAC AJ - FSouth Dakota
    Noridian Healthcare Solutions, LLC A and B MAC03402 - MAC BJ - FSouth Dakota
    Noridian Healthcare Solutions, LLC A and B MAC03501 - MAC AJ - FUtah
    Noridian Healthcare Solutions, LLC A and B MAC03502 - MAC BJ - FUtah
    Noridian Healthcare Solutions, LLC A and B MAC03601 - MAC AJ - FWyoming
    Noridian Healthcare Solutions, LLC A and B MAC03602 - MAC BJ - FWyoming

    Expand/Collapse the browser section LCD Information

    Document Information

    LCD ID
    L34076

    LCD Title
    Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma

    Proposed LCD in Comment Period
    N/A

    Source Proposed LCD
    DL34076

    AMA CPT / ADA CDT / AHA NUBC Copyright Statement
    CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

    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.

    Current Dental Terminology © 2020 American Dental Association. All rights reserved.

    Copyright © 2013 - 2020, the American Hospital Association, Chicago, Illinois. Reproduced by CMS with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB-04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312-893-6816. Making copies or utilizing the content of the UB-04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB-04 Manual and/or codes and descriptions; and/or making any commercial use of UB-04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. To license the electronic data file of UB-04 Data Specifications, contact Tim Carlson at (312) 893-6816. You may also contact us at ub04@aha.org.

    Original Effective Date
    For services performed on or after 10/01/2015

    Revision Effective Date
    For services performed on or after 10/01/2019

    Revision Ending Date
    N/A

    Retirement Date
    N/A

    Notice Period Start Date
    04/06/2017

    Notice Period End Date
    05/21/2017

    CMS National Coverage Policy
    Title XVIII of the Social Security Act, 1862(a)(1)(A) allows coverage and payment for only those services that are considered to be medically reasonable and necessary.

    Title XVIII of the Social Security Act, Section 1833(e). This section prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

    CMS Manual System, Pub. 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 2, §150.7.
    Coverage Guidance
    Coverage Indications, Limitations, and/or Medical Necessity

    This policy addresses the injection of chemical substances, such as local anesthetics, steroids, sclerosing agents and/or neurolytic agents into ganglion cysts, tendon sheaths, tendon origins/insertions, ligaments or near nerves of the feet (e.g., Morton's neuroma) to affect therapy for a pathological condition.

    Note: the term "Morton's neuroma" is used in this policy generically to refer to a swollen inflamed nerve in the ball of the foot, including the more specific conditions of Morton's neuroma (lesion within the third intermetatarsal space), Heuter's neuroma (first intermetatarsal space), Hauser's neuroma (second intermetatarsal space) and Iselin's neuroma (fourth intermetatarsal space). This policy applies to each.

    Injection of a carpal tunnel or tarsal tunnel is indicated for the patient with a mild case of these syndromes, with or without a trial of other conservative measures, such as oral non-steroidal anti-inflammatory drugs (NSAIDs) or orthoses.

    Injection into tendon sheaths, ligaments, tendon origins or insertions, ganglion cysts, neuromas or other areas described by this policy may be indicated to relieve pain or dysfunction resulting from inflammation or other pathological changes. Proper use of this modality with local anesthetics and/or steroids should be short-term, as part of an overall management plan including diagnostic evaluation, in order to clearly identify and properly treat the primary cause. In some circumstances after diagnosis has been confirmed, injection of a sclerosing or neurolytic agent may be appropriate for longer-term management.

    The signs or symptoms that justify these treatments should be resolved or reevaluated after one to three injections (see reference 2 below, under "Sources of Information and Basis for Decision"). Injections beyond three to the same tendon origin/insertion, tendon sheath, ganglion, neuroma, ligament or local area in a six month period must be justified by the clinical record indicating a logical reason for failure of the prior therapy and why further treatment can reasonably be expected to succeed. A recurrence may justify a second course of therapy.

    Medical necessity for injections of more than two sites at one session or for frequent or repeated injections is questionable. Such injections are likely to result in a request for medical records which must evidence careful justification of necessity.

    "Dry needling" of ganglion cysts, ligaments, neuromas, tendon sheaths and their origins/insertions are non-covered procedures.

    Compliance with the provisions in this policy is subject to monitoring by post payment data analysis and subsequent medical review.



    Summary of Evidence

    N/A



    Analysis of Evidence
    (Rationale for Determination)

    N/A


    Expand/Collapse the General Information section General Information

    Associated Information
    N/A
    Sources of Information
    1. Scientific American Medical; Physiatry Section, PRMA; Rheumatology Section, PRMA.

    2. Snider RK. Essentials of Musculoskeletal Care. Greene WF. ed. Rosemont, IL: American Academy of Orthopedic Surgeons; 1997:39.
    Bibliography

    N/A

    Expand/Collapse the Revision History section Revision History Information

    Revision History DateRevision History NumberRevision History ExplanationReason(s) for Change
    10/01/2019 R5

    The LCD is revised to remove CPT/HCPCS codes in the Keyword Section of the LCD.

    At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.
    • Other (The LCD is revised to remove CPT/HCPCS codes in the Keyword Section of the LCD.
      )
    10/01/2019 R4

    As required by CR 10901, all billing and coding information has been moved to the companion article, this article is linked to the LCD.

    At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all of the fields included on the LCD are applicable as noted in this policy.
    • Revisions Due To Code Removal
    05/22/2017 R3 This LCD is the result of DL34076 being released to final.
    • Creation of Uniform LCDs Within a MAC Jurisdiction
    10/01/2016 R2 LCD is revised to add/delete the following diagnosis codes effective 10/1/16:
    Added codes: G56.03, G57.53, G5763, S0341XA, S0341XD, S0341XS, S0342XA, S0342XD, S0342XS, S0343XA, S0343XD and S0343XS.
    Deleted codes: S03.4XXA, S03.4XXD and S03.4XXS.

    Part A contract numbers are added to this LCD.


    • Creation of Uniform LCDs Within a MAC Jurisdiction
    • Revisions Due To ICD-10-CM Code Changes
    10/01/2015 R1 This LCD is revised to remove the paragraph, “When requesting an individual consideration through the written redetermination (formerly appeal) process, providers must include all relevant medical records and literature that supports the request. “ from the Associated Information field.
    • Other (Removed the paragraph, “When requesting an individual consideration through the written redetermination (formerly appeal) process, providers must include all relevant medical records and literature that supports the request.”)

    Expand/Collapse the Associated Documents section Associated Documents

    Attachments
    N/A
    Related Local Coverage Documents
    Article(s)
    A57201 - Billing and Coding: Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma opens in new window
    A55490 - Response to Comments: Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma opens in new window
    LCD(s)
    DL34076 - (MCD Archive Site)
    Related National Coverage Documents
    N/A
    Public Version(s)
    Updated on 01/29/2020 with effective dates 10/01/2019 - N/A
    Updated on 09/18/2019 with effective dates 10/01/2019 - N/A
    Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

    Expand/Collapse the Keywords section Keywords

    • injection
    • tendon
    • ligament
    • ganglion cyst
    • tunnel morton's
    • neuroma
    • carpal
    • tarsal
    Read the LCD Disclaimer opens in new window
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