Local Coverage Determination (LCD)

CT of the Head

L34417

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Contractor Information

Contractor Name	Contract Type	Contract Number	Jurisdiction	States
Palmetto GBA	A and B MAC	10111 - MAC A	J - J	Alabama
Palmetto GBA	A and B MAC	10112 - MAC B	J - J	Alabama
Palmetto GBA	A and B MAC	10211 - MAC A	J - J	Georgia
Palmetto GBA	A and B MAC	10212 - MAC B	J - J	Georgia
Palmetto GBA	A and B MAC	10311 - MAC A	J - J	Tennessee
Palmetto GBA	A and B MAC	10312 - MAC B	J - J	Tennessee
Palmetto GBA	A and B and HHH MAC	11201 - MAC A	J - M	South Carolina
Palmetto GBA	A and B and HHH MAC	11202 - MAC B	J - M	South Carolina
Palmetto GBA	A and B and HHH MAC	11301 - MAC A	J - M	Virginia
Palmetto GBA	A and B and HHH MAC	11302 - MAC B	J - M	Virginia
Palmetto GBA	A and B and HHH MAC	11401 - MAC A	J - M	West Virginia
Palmetto GBA	A and B and HHH MAC	11402 - MAC B	J - M	West Virginia
Palmetto GBA	A and B and HHH MAC	11501 - MAC A	J - M	North Carolina
Palmetto GBA	A and B and HHH MAC	11502 - MAC B	J - M	North Carolina

LCD Information

Document Information

LCD ID
L34417

LCD Title
CT of the Head

Proposed LCD in Comment Period
N/A

Source Proposed LCD
DL34417

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

Revision Effective Date
For services performed on or after 08/17/2023

Revision Ending Date
N/A

Retirement Date
N/A

Notice Period Start Date
04/27/2017

Notice Period End Date
06/11/2017

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.

Copyright © 2024, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the 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. 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.

Issue

Issue Description

This LCD outlines limited coverage for this service with specific details under Coverage Indications, Limitations and/or Medical Necessity.

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 reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

42 CFR §410.32(a)(b) Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions

CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 4, §220.1 Computed Tomography (CT)

Coverage Guidance

Coverage Indications, Limitations, and/or Medical Necessity

A cranial computerized tomographic (CT) scan is a very useful and informative neurodiagnostic tool. Scanning of the head in successive layers by a narrow beam of x-rays enables the transmission of x-ray photons in each layer to be measured. A computer is used to process the accumulated x-ray photon data and constructs a graphic image of a tomographic slice. Normal intracranial structures and a wide variety of intracranial disorders may be demonstrated. A cranial CT scan may be ordered without contrast, with injection of standard roentgenographic contrast material or without contrast material, followed by contrast material and further sections. Contrast administration is not without risk to the patient and for some conditions adds little or no benefit to the examination.

Cranial CT scans are determined to be reasonable and necessary and are a covered service when the patient has clinical evidence of an intracranial disorder or an established intracranial disorder or disease. The general indications for use of contrast CT scanning are:

1. To assess perfusion (e.g., cerebrovascular accident [CVA])

2. To characterize a specific lesion

3. To detect defects in blood/brain barrier (e.g., infarcts, tumors, infection, vasculitis)

4. To detect neovascularity (tumors); or

5. For staging of known lung cancer, breast cancer, and lymphomas which are likely to metastasize early to the brain

Summary of Evidence

N/A

Analysis of Evidence (Rationale for Determination)

N/A

Proposed Process Information

Synopsis of Changes

Changes	Fields Changed
	N/A

Associated Information

Sources of Information

Bibliography

Open Meetings

Contractor Advisory Committee (CAC) Meetings

MAC Meeting Information URLs

Proposed LCD Posting Date

Comment Period Start Date

Comment Period End Date

Reason for Proposed LCD

Requestor Name	Requestor Letter
	View Letter

Requestor Information

Contact for Comments on Proposed LCD

Coding Information

Bill Type Codes

Code	Description
Please accept the License to see the codes.

Revenue Codes

Code	Description
Please accept the License to see the codes.

ICD-10-CM Codes that Support Medical Necessity

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

Additional ICD-10 Information

General Information

Associated Information

Documentation Requirements

The patient's medical record should include symptomatology indicating the medical necessity of this test.

Documentation supporting medical necessity should be legible, maintained in the patient's medical record, and must be made available to the A/B MAC upon request.

Sources of Information
N/A

Bibliography

Clinch CR. Evaluation of acute headaches in adults. American Family Physician. 2001;63(4):685-692.

Edlow JA. Diagnosis of subarachnoid hemorrhage in the emergency department. Emergency Medicine Clinics of North America. 2003;21(1):73-87.

Edlow JA, Panagos PD, Godwin SA, Thomas TL, Decker WW. Clinical policy: Critical issues in the evaluation and management of adult patients presenting to the emergency department with acute headache. Annals of Emergency Medicine. 2008;52(4):407-436.

Eng J, Chanmugam A. Examining the role of cranial CT in the evaluation of patients with minor head injury: A systematic review. Neuroimaging Clinics of North America. 2003;13(2):273-282.

Hasbun R, Abrahams J, Jekel J, Quagliarello VJ. Computed tomography of the head before lumbar puncture in adults with suspected meningitis. The New England Journal of Medicine. 2001;345(24):1727-1733.

Inamasu J, Hori S, Aoki K, Suga S, Kawase T, Aikawa N. CT scans essential after posttraumatic loss of consciousness. The American Journal of Emerg Medicine. 2000;18(7):810-811.

Vilke GM, Chan TC, Guss DA. Use of a complete neurological examination to screen for significant intracranial abnormalities in minor head injury. The American Journal of Emerg Medicine. 2000;18(2):159-163.

Revision History Information

Revision History Date	Revision History Number	Revision History Explanation	Reasons for Change
08/17/2023	R20	Under *CMS National Coverage Policy* updated section headings for regulations. Under *Coverage Indications, Limitations and/or Medical Necessity* removed codes from first paragraph. Under *Bibliography* changes were made to citations to reflect AMA citation guidelines. Formatting and punctuation were corrected throughout the LCD. Acronyms were inserted and defined where appropriate throughout the LCD.	Provider Education/Guidance
10/10/2019	R19	This LCD is being revised in order to adhere to CMS requirements per chapter 13, section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs. There has been no change in coverage with this LCD revision. Title XVIII of the Social Security Act, §1833(e) was removed from the *CMS National Coverage Policy* section of this LCD and placed in the related Billing and Coding: CT of the Head A56612 article. At this time 21^stCentury 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.	Provider Education/Guidance
07/04/2019	R18	Under *Bibliography* changes were made to citations to reflect AMA citation guidelines. At this time 21^stCentury 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.	Provider Education/Guidance
06/06/2019	R17	All coding located in the *Coding Information* section and all verbiage regarding billing and coding under the *Associated Information* *Documentation Requirements* section has been removed and is included in the related Billing and Coding: CT of the Head A56612 article. At this time 21^stCentury 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.	Provider Education/Guidance
10/01/2018	R16	Under *ICD-10 Codes that Support Medical Necessity: Group 1* added ICD-10 codes C43.111, C43.112, C43.121, C43.122, C44.1021, C44.1022, C44.1091, C44.1092, C44.1121, C44.1122, C44.1191, C44.1192, C44.1221, C44.1222, C44.1291, C44.1292, C44.1321, C44.1322, C44.1391, C44.1392, C44.1921, C44.1922, C44.1991, C44.1992, C4A.111, C4A.112, C4A.121, C4A.122, F53.0, F53.1. G51.31, G51.32, G51.33, G51.39, H02.23A, H02.23B, H02.23C, I63.81, I63.89, I67.850, I67.858, T81.40XA, T81.40XD, T81.40XS, T81.41XA, T81.41XD, T81.41XS, T81.42XA, T81.42XD, T81.42XS, T81.43XA, T81.43XD, T81.43XS, T81.44XA, T81.44XD, T81.44XS, T81.49XA, T81.49XD, and T81.49XS. Under *ICD-10 Codes that Support Medical Necessity: Group 1* deleted ICD-10 codes C44.102, C44.109, C44.122, C44.129, C44.192, C44.199, F53, G51.3, I63.8, T81.4XXA, T81.4XXD, and T81.4XXS. Under *ICD-10 Codes that Support Medical Necessity: Group 1* the code description was revised for ICD-10 codes I63.333 and I63.343. This revision is due to the 2018 Annual ICD-10 Code Update and is effective on October 1, 2018. At this time 21^stCentury 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.	Revisions Due To ICD-10-CM Code Changes
05/28/2018	R15	Throughout the entire LCD, punctuation was corrected as necessary. Under *Coverage Indications, Limitations and/or Medical Necessity* changed the “C” in the word “Cranial” to lower case and added an “A” at the beginning of the first and fifth sentences in the first paragraph. In the second paragraph, the words “Computerized Tomographic” was replaced with the acronym “CT” and changed the “S” in the word “Scans” to lower case. Under *ICD-10 Codes That Support Medical Necessity – Group 1 Codes* added the ICD-10 code S02.11GG as it was inadvertently omitted. Under *Bibliography* changes were made to citations to reflect AMA citation guidelines”. In the first citation, the authors’ names were added and the word “adult” was added before the word “patients”. At this time 21^stCentury 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.	Provider Education/Guidance
02/26/2018	R14	The Jurisdiction "J" Part B Contracts for Alabama (10112), Georgia (10212) and Tennessee (10312) are now being serviced by Palmetto GBA. The notice period for this LCD begins on 12/14/17 and ends on 02/25/18. Effective 02/26/18, these three contract numbers are being added to this LCD. No coverage, coding or other substantive changes (beyond the addition of the 3 Part B contract numbers) have been completed in this revision.	Change in Affiliated Contract Numbers
01/29/2018	R13	The Jurisdiction "J" Part A Contracts for Alabama (10111), Georgia (10211) and Tennessee (10311) are now being serviced by Palmetto GBA. The notice period for this LCD begins on 12/14/17 and ends on 01/28/18. Effective 01/29/18, these three contract numbers are being added to this LCD. No coverage, coding or other substantive changes (beyond the addition of the 3 Part A contract numbers) have been completed in this revision.	Change in Affiliated Contract Numbers
11/29/2017	R12	Under ICD-10 Codes that Support Medical Necessity added ICD-10 code R53.1. 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.	Provider Education/Guidance Reconsideration Request
10/01/2017	R11	Under *ICD-10 Codes that Support Medical Necessity Group1: Codes* deleted ICD-10 codes C96.2 and E85.8. Under *ICD-10 Codes That Support Medical Necessity Group 1: Codes* added ICD-10 codes E85.81, E85.82, E85.89, F10.11 and G12.24. Under *ICD-10 Codes That Support Medical Necessity Group 1:Codes* code description changes were made to ICD-10 codes I63.211, I63.212, I63.22, I63.323, I63.333, I63.513, I63.523, I63.533, S04.031A, S04.031D, S04.031S, S04.032A, S04.032D, S04.032S, S04.041A, S04.041D, S04.041S, S04.042A, S04.042D and S04.042S. This revision is due to the 2017 Annual ICD-10 Code Updates. 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.	Revisions Due To ICD-10-CM Code Changes
08/03/2017	R10	Under ICD-10 Codes that Support Medical Necessity added ICD-10 code R56.9.	Provider Education/Guidance Revisions Due To ICD-10-CM Code Changes Reconsideration Request
06/12/2017	R9	Under *ICD-10 Codes that Support Medical Necessity- removed unspecified eye and ear codes H34.8191, H34.8192, H34.8390, H34.8391, H34.8392, H59.339, H59.349, H59.359, H59.369, H93.A9. These codes were added to the LCD S00.03XA, S01.01XA, S00.02XA, S01.03XA, S01.04XA. Under Sources of Information and Basis for Decision*- updated version and title name of the first article listed in references.	Provider Education/Guidance Revisions Due To ICD-10-CM Code Changes
10/01/2016	R8	Under *ICD-10 Codes That Support Medical Necessity: Group 1* C49.A0, C49.A1, C49.A2, C49.A3, C49.A4, C49.A5, C49.A9, D47.Z2, D49.511, D49.512, D49.519, D49.59, E89.820, E89.821, E89.822, E89.823, G97.61, G97.62, G97.63, G97.64, H34.8110, H34.8111, H34.8112, H34.8120, H34.8121, H34.8122, H34.8130, H34.8131, H34.8132, H34.8191, H34.8192, H34.8310, H34.8311, H34.8312, H34.8320, H34.8321, H34.8322, H34.8330, H34.8331, H34.8332, H34.8390, H34.8391, H34.8392, H59.331, H59.332, H59.333, H59.339, H59.341, H59.342, H59.343, H59.349, H59.351, H59.352, H59.353, H59.359, H59.361, H59.362, H59.363, H59.369, H90.A11, H90.A12, H90.A31, H90.A32, H93.A1, H93.A2, H93.A3, H93.A9, H95.51, H95.52, H95.53, H95.54, I60.2, I63.013, I63.033, I63.113, I63.133, I63.213, I63.233, I63.313, I63.323, I63.333, I63.343, I63.413, I63.423, I63.433 , I63.443, I63.513, I63.523, I63.533, I63.543, I69.010, I69.011, I69.012, I69.013, I69.014, I69.015, I69.018, I69.019, I69.110, I69.111, I69.112, I69.113, I69.114, I69.115, I69.118, I69.119, I69.210, I69.21,1 I69.212, I69.213, I69.214, I69.215, I69.218, I69.219, I69.310, I69.31,1 I69.312, I69.313, I69.314, I69.315, I69.318, I69.319, I69.810, I69.811, I69.812, I69.813, I69.814, I69.815, I69.818, I69.819, I69.910, I69.91,1 I69.912, I69.913, I69.914, I69.915, I69.918, I69.919, I72.5, I72.6, I77.75, I77.76, L03.213, O14.04, O14.05, O14.14, O14.15, O14.24, O14.25, O14.94, O14.95, Q87.82 R29.700, R29.701, R29.702, R29.703, R29.704, R29.705, R29.706, R29.707, R29.708, R29.709, R29.710, R29.711, R29.712, R29.713, R29.714, R29.715, R29.716, R29.717, R29.718, R29.719, R29.720, R29.721, R29.722, R29.723, R29.724, R29.725, R29.726, R29.727, R29.728, R29.729, R29.730, R29.731, R29.732, R29.733, R29.734, R29.735, R29.736, R29.737, R29.738, R29.739, R29.740, R29.741, R29.742, R40.2410, R40.2411, R40.2412, R40.2413, R40.2414, R40.2420, R40.2421, R40.2422, R40.2423, R40.2424, R40.2430, R40.2431, R40.2432, R40.2433, R40.2434, R40.2440, R40.2441, R40.2442, R40.2443, R40.2444, S02.101A, S02.101B, S02.101D, S02.101G, S02.101K, S02.101S, S02.102A, S02.102B, S02.102D, S02.102G, S02.102K, S02.102S, S02.109A, S02.109B, S02.109D, S02.109G, S02.109K, S02.109S, S02.11AA, S02.11AB, S02.11AD, S02.11AG, S02.11AK, S02.11AS, S02.11BA, S02.11BB, S02.11BD, S02.11BG, S02.11BK, S02.11BS, S02.11CA, S02.11CB, S02.11CD, S02.11CG, S02.11CK, S02.11CS, S02.11DA, S02.11DB, S02.11DD, S02.11DG, S02.11DK, S02.11DS, S02.11EA, S02.11EB, S02.11ED, S02.11EG, S02.11EK, S02.11ES, S02.11FA, S02.11FB, S02.11FD, S02.11FG, S02.11FK, S02.11FS, S02.11GA, S02.11GB, S02.11GD, S02.11GK, S02.11GS, S02.11HA, S02.11HB, S02.11HD, S02.11HG, S02.11HK, S02.11HS, S02.30XA, S02.30XB, S02.31XA, S02.31XB, S02.30XD, S02.30XG, S02.30XK, S02.30XS, S02.32XA, S02.32XB, S02.32XD, S02.32XG, S02.32XK, S02.32XS, S02.40AA, S02.40AB, S02.40AD, S02.40AG, S02.40AK, S02.40AS, S02.40BA, S02.40BB, S02.40BD, S02.40BG, S02.40BK, S02.40BS, S02.40CA, S02.40CB, S02.40CD, S02.40CG, S02.40CK, S02.40CS, S02.40DA, S02.40DB, S02.40DD, S02.40DG, S02.40DK, S02.40DS, S02.40EA, S02.40EB, S02.40ED, S02.40EG, S02.40EK, S02.40ES, S02.40FA, S02.40FB, S02.40FD, S02.40FG, S02.40FK, S02.40FS, S02.601A, S02.601B, S02.601D, S02.601G, S02.601K, S02.601S, S02.602A, S02.602B, S02.602D, S02.602G, S02.602K, S02.602S, S02.610A, S02.610B, S02.610D, S02.610G, S02.610K, S02.610S, S02.611A, S02.611B, S02.611D, S02.611G, S02.611K, S02.611S, S02.612A, S02.612B, S02.612D, S02.612G, S02.612K, S02.612S, S02.620A, S02.620B, S02.620D, S02.620G, S02.620K, S02.620S, S02.621A, S02.621B, S02.621D, S02.621G, S02.621K, S02.621S, S02.622A, S02.622B, S02.622D, S02.622G, S02.622K, S02.622S, S02.630A, S02.630B, S02.630D, S02.630G, S02.630K, S02.630S, S02.631A, S02.631B, S02.631D,S02.631G, S02.631K, S02.631S, S02.632A, S02.632B, S02.632D, S02.632G, S02.632K, S02.632S, S02.640A, S02.640B, S02.640D, S02.640G, S02.640K, S02.640S, S02.641A, S02.641B, S02.641D, S02.641G, S02.641K, S02.641S, S02.642A, S02.642B, S02.642D, S02.642G, S02.642K, S02.642S, S02.650A, S02.650B, S02.650D, S02.650G, S02.650K, S02.650S, S02.651A, S02.651B, S02.651D, S02.651G, S02.651K, S02.651S, S02.652A, S02.652B, S02.652D, S02.652G, S02.652K, S02.652S, S02.670A, S02.670B, S02.670D, S02.670G, S02.670K, S02.670S, S02.671A, S02.671B, S02.671D, S02.671G, S02.671K, S02.671S, S02.672A, S02.672B, S02.672D, S02.672G, S02.672K, S02.672S, S02.80XA, S02.80XB, S02.80XD, S02.80XG, S02.80XK, S02.80XS, S02.81XA, S02.81XB, S02.81XD, S02.81XG, S02.81XK, S02.81XS, S02.82XA, S02.82XB, S02.82XD, S02.82XG, S02.82XK and S02.82XS. Under *ICD-10 Codes That Support Medical Necessity: Group 1* deleted I60.21, I60.22, I69.01, I69.11, I69.21, I69.31, I69.81, I69.91, I97.62, S02.10XA, S02.10XB, S02.10XD, S02.10XG, S02.10XK, S02.10XS, S02.3XXA, S02.3XXB, S02.3XXD, S02.3XXG, S02.3XXK, S02.3XXS, S02.61XA, S02.61XB, S02.61XD, S02.61XG, S02.61XK, S02.61XS, S02.62XA, S02.62XB, S02.62XD, S02.62XG, S02.62XK, S02.62XS, S02.63XA, S02.63XB, S02.63XD, S02.63XG, S02.63XK, S02.63XS, S02.64XA, S02.64XB, S02.64XD, S02.64XG, S02.64XK, S02.64XS, S02.65XA, S02.65XB, S02.65XD, S02.65XG, S02.65XK, S02.65XS, S02.67XA, S02.67XB, S02.67XD, S02.67XG, S02.67XK, S02.67XS, S02.8XXA, S02.8XXB, S02.8XXD, S02.8XXG, S02.8XXK, S02.8XXS, S06.0X2A, S06.0X2D, S06.0X2S, S06.0X3A, S06.0X3D, S06.0X3S, S06.0X4A, S06.0X4D, S06.0X4S, S06.0X5A, S06.0X5D, S06.0X5S, S06.0X6A, S06.0X6D and S06.0X6S. Under *ICD-10 Codes That Support Medical Necessity: Group 1* updated code description for C7A.094, C7A.095, C7A.096, C81.10, C81.11, C81.12, C81.13, C81.14, C81.15, C81.16, C81.17, C81.18, C81.19, C81.20, C81.21, C81.22, C81.23, C81.24, C81.25, C81.26, C81.27, C81.28, C81.29, C81.30, C81.31, C81.32, C81.33, C81.34, C81.35, C81.36, C81.37, C81.38, C81.39, C81.40, C81.41, C81.42, C81.43, C81.44, C81.45, C81.46, C81.47, C81.48, C81.49, C81.70, C81.71, C81.72, C81.73, C81.74, C81.75, C81.76, C81.77, C81.78, C81.79, D3A.094, D3A.095, D3A.096, G97.51, G97.52, H59.311, H59.312, H59.313, H59.321, H59.322, H59.323, H95.41, H95.42, I97.610, I97.611, I97.618, S02.110A, S02.110B, S02.110D, S02.110G, S02.110K, S02.110S, S02.111A, S02.111B, S02.111D, S02.111G, S02.111K, S02.111S, S02.112A, S02.112B, S02.112D, S02.112G, S02.112K, S02.112S, S02.118A, S02.118B, S02.118D, S02.118G, S02.118K, S02.118S, S02.400A, S02.400B, S02.400D, S02.400G, S02.400K, S02.400S, S02.401A, S02.401B, S02.401D, S02.401G, S02.401K, S02.401S, S02.402A, S02.402B, S02.402D, S02.402G, S02.402K, S02.402S, S02.600A, S02.600B, S02.600D, S02.600G, S02.600K, S02.600S, T82.817A, T82.817D, T82.817S, T82.818A, T82.818D, T82.818S, T82.838A, T82.838D, T82.838S, T85.110A, T85.110D, T85.110S, T85.120A, T85.120D, T85.120S, T85.190A, T85.190D and T85.190S. This revision is due to the Annual ICD-10 Code Update and becomes effective October 1, 2016.	Provider Education/Guidance Revisions Due To ICD-10-CM Code Changes
04/28/2016	R7	Under *Coverage Indications, Limitations and/or Medical Necessity* added verbiage to statements 1-4 for clarification. Under *Associated Information-Documentation Requirements* added “the” and deleted “and” from statement 2.b. and deleted “the” from statement #5. Under *Sources of Information and Basis for Decision* corrected the page number for the following: Clinch CR. Evaluation of Acute Headaches in Adults. American Family Physician. 2001;63(4):685-692.	Provider Education/Guidance Typographical Error
01/14/2016	R6	Under *ICD-10 Codes That Support Medical Necessity* added ICD-10 code C4A.4.	Provider Education/Guidance Reconsideration Request
10/22/2015	R5	Under *ICD-10 Codes That Support Medical Necessity* added R42 as this ICD-10 code was inadvertently omitted during the translation of the LCD from ICD-9 to ICD-10.	Provider Education/Guidance Reconsideration Request Other (ICD-10 code was inadvertently omitted during the translation of the LCD from ICD-9 to ICD-10)
10/01/2015	R4	Per CMS Internet-Only Manual, Pub 100-08, Medicare Program Integrity Manual, Chapter 13, §13.1.3 LCDs consist of only “reasonable and necessary” information. All bill type and revenue codes have been removed.	Other (Per CMS Internet-Only Manual, Pub 100-08, Medicare Program Integrity Manual, Chapter 13, §13.1.3 LCDs consist of only “reasonable and necessary” information. All bill type and revenue codes have been removed.)
10/01/2015	R3	Under *CMS National Coverage Policy* added Title XVIII of the Social Security Act, §1833(e) and corrected the title cited for 42 CFR §410.32 (a)(b). Under *Coverage Indications, Limitations and/or Medical Necessity* corrected the spelling of “slice” in the third sentence of the first paragraph. Under *ICD-10 Codes That Support Medical Necessity* added the following ICD-10 codes: S09.8XXA, S09.8XXD, S09.8XXS, S09.90XA, S09.90XD, and S09.90XS. Under *Associated Information-Documentation Requirements* corrected statement #3 to now read, “Any claim billed with ICD-10 code R51 (headache) or G44.1 (Vascular headache, not elsewhere classified) may be subject to manual review.” Statement #4 was corrected to now read, “Claims billed with ICD-10 codes S09.19XA (Other specified injury of muscle and tendon of head, initial encounter), S09.19XD (Other specified injury of muscle and tendon of head, subsequent encounter) , S09.19XS (Other specified injury of muscle and tendon of head, sequela), S09.8XXA (Other specified injuries of head, initial encounter), S09.8XXD (Other specified injuries of head, subsequent encounter), S09.8XXS (Other specified injuries of head, sequela), S09.90XA (Unspecified injury of head, initial encounter), S09.90XD (Unspecified injury of head, subsequent encounter), or S09.90XS (Unspecified injury of head, sequela) should have documented associated signs and symptoms to support the need for CT scan of the head and may be subject to manual review.” Under *Sources of Information and Basis for Decision* deleted “et al” and added author names to the following journal citation: Inamasu J, Hori S, Aoki K, Suga S, Kawase T, Aikawa N. CT scans essential after posttraumatic loss of consciousness. The American Journal of Emerg Medicine. 2000;18(7):810-811. The page number was corrected to now read “693” for the following: Clinch CR. Evaluation of Acute Headaches in Adults. American Family Physician. 2001;63(4):685-693.	Provider Education/Guidance Typographical Error Other
10/01/2015	R2	Under Sources of Information and Basis for Decision added citations for American College of Emergency Physicians. Clinical policy: Critical issues in the evaluation and management of patients presenting to the emergency department with acute headache; Hasbun R, Abrahams J, Jekel J, Quagliarello VJ. Computed Tomography of the head before lumbar puncture in adults with suspected meningitis; Vilke GM, Chan TC, Guss DA. Use of a Complete Neurological Examination to Screen for Significant Intracranial Abnormalities in Minor Head Injury; Inamasu J, Hori S, Aoki K, Suga S, et. al. CT scans essential after posttraumatic loss of consciousness; Edlow JA. Diagnosis of subarachnoid hemorrhage in the emergency department; Clinch CR. Evaluation of Acute Headaches in Adults; Eng J, Chanmugam A. Examining the Role of Cranial CT in the Evaluation of Patients with Minor Head Injury: a Systematic Review.	Provider Education/Guidance Other (Annual validation)
10/01/2015	R1	Under *ICD-10 Codes That Support Medical Necessity* effective 06/29/2014, the following invalid codes were deleted due to the 2014 & 2015 Annual ICD-10 Code Update: T40.1X5A, T40.1X5D, T40.1X5S, T40.8X5A, T40.8X5D, and T40.8X5S. This revision becomes effective 10/01/2014.	Provider Education/Guidance Revisions Due To ICD-10-CM Code Changes

Associated Documents

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Related Local Coverage Documents
Articles
A56612 - Billing and Coding: CT of the Head
A55517 - Response to Comments: CT of the Head (MCD Archive Site)
LCDs
DL34417 - CT of the Head (MCD Archive Site)

Related National Coverage Documents
NCDs
220.1 - Computed Tomography

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Keywords

CT Scan
CT of the Head
Computerized Tomography

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CT of the Head

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