Local Coverage Article Billing and Coding

Billing and Coding: Reporting a Non-Covered Test Performed in Preparation for a Non-Covered Procedure

A55775

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Contractor Information

Article Information

General Information

Article ID
A55775
Article Title
Billing and Coding: Reporting a Non-Covered Test Performed in Preparation for a Non-Covered Procedure
Article Type
Billing and Coding
Original Effective Date
10/23/2017
Revision Effective Date
10/23/2017
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2022 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.

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CMS National Coverage Policy

N/A

Article Guidance

Article Text

When a diagnostic test is necessary for the performance of a non-covered service, that test typically may not be covered.  For instance, when planning a cataract surgery using a non-covered, presbyopia and astigmatism correcting intraocular lens, it is often necessary to first perform a computerized corneal typography. Noridian wishes to remind providers to report this appropriately as a non-covered test by submitting the code 92025 with a -GY modifier.

 

Effective Immediately

 

Reference:

Internet Only Manual (IOM) Medicare National Coverage Determinations (NCD) Manual, Publication 100-03, Chapter 1, Part 1, Section 10.1;  IOM Medicare Claims Processing Manual, Publication 100-04, Chapter 32, Section 120.

 

 

 

Coding Information

CPT/HCPCS Codes

Group 1

Group 1 Paragraph

92025

-GY MODIFIER

Group 1 Codes

N/A

CPT/HCPCS Modifiers

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ICD-10-CM Codes that Support Medical Necessity

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ICD-10-CM Codes that DO NOT Support Medical Necessity

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Additional ICD-10 Information

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Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

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Other Coding Information

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
10/23/2017 R1

Converted to Billing and Coding article type only. No changes to article content.

Associated Documents

Related Local Coverage Documents
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Related National Coverage Documents
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
05/08/2020 10/23/2017 - N/A Currently in Effect You are here
10/23/2017 10/23/2017 - N/A Superseded View

Keywords

  • Non-Covered Test
  • Non-Covered Procedure
  • 92025