10/01/2019
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R4
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Effective 10/07/2018, G25.0 added as this is a covered indication.
Effective 10/01/2019, the following ICD-10 codes were added an deleted and code description was changed per the 2019 annual update
Added:
- H81.4 - Vertigo of central origin
- R11.15 - Cyclical vomiting syndrome unrelated to migraine
- S02.121A - Fracture of orbital roof, right side, initial encounter for closed fracture
- S02.121B - Fracture of orbital roof, right side, initial encounter for open fracture
- S02.121D - Fracture of orbital roof, right side, subsequent encounter for fracture with routine healing
- S02.121G - Fracture of orbital roof, right side, subsequent encounter for fracture with delayed healing
- S02.121K - Fracture of orbital roof, right side, subsequent encounter for fracture with nonunion
- S02.121S - Fracture of orbital roof, right side, sequela
- S02.122A - Fracture of orbital roof, left side, initial encounter for closed fracture
- S02.122B - Fracture of orbital roof, left side, initial encounter for open fracture
- S02.122D - Fracture of orbital roof, left side, subsequent encounter for fracture with routine healing
- S02.122G - Fracture of orbital roof, left side, subsequent encounter for fracture with delayed healing
- S02.122K - Fracture of orbital roof, left side, subsequent encounter for fracture with nonunion
- S02.122S - Fracture of orbital roof, left side, sequela
- S02.831A - Fracture of medial orbital wall, right side, initial encounter for closed fracture
- S02.831B - Fracture of medial orbital wall, right side, initial encounter for open fracture
- S02.831D - Fracture of medial orbital wall, right side, subsequent encounter for fracture with routine healing
- S02.831G - Fracture of medial orbital wall, right side, subsequent encounter for fracture with delayed healing
- S02.831K - Fracture of medial orbital wall, right side, subsequent encounter for fracture with nonunion
- S02.831S - Fracture of medial orbital wall, right side, sequela
- S02.832A - Fracture of medial orbital wall, left side, initial encounter for closed fracture
- S02.832B - Fracture of medial orbital wall, left side, initial encounter for open fracture
- S02.832D - Fracture of medial orbital wall, left side, subsequent encounter for fracture with routine healing
- S02.832G - Fracture of medial orbital wall, left side, subsequent encounter for fracture with delayed healing
- S02.832K - Fracture of medial orbital wall, left side, subsequent encounter for fracture with nonunion
- S02.832S - Fracture of medial orbital wall, left side, sequel
- S02.841A - Fracture of lateral orbital wall, right side, initial encounter for closed fracture
- S02.841B - Fracture of lateral orbital wall, right side, initial encounter for open fracture
- S02.841D - Fracture of lateral orbital wall, right side, subsequent encounter for fracture with routine healing
- S02.841G - Fracture of lateral orbital wall, right side, subsequent encounter for fracture with delayed healing
- S02.841K - Fracture of lateral orbital wall, right side, subsequent encounter for fracture with nonunion
- S02.841S - Fracture of lateral orbital wall, right side, sequela
- S02.842A - Fracture of lateral orbital wall, left side, initial encounter for closed fracture
- S02.842B - Fracture of lateral orbital wall, left side, initial encounter for open fracture
- S02.842D - Fracture of lateral orbital wall, left side, subsequent encounter for fracture with routine healing
- S02.842G - Fracture of lateral orbital wall, left side, subsequent encounter for fracture with delayed healing
- S02.842K - Fracture of lateral orbital wall, left side, subsequent encounter for fracture with nonunion
- S02.842S - Fracture of lateral orbital wall, left side, sequel
- Z86.003 - Personal history of in-situ neoplasm of oral cavity, esophagus and stomach
- Z86.005 - Personal history of in-situ neoplasm of middle ear and respiratory system
- Z86.006 - Personal history of melanoma in-situ
- Z86.007 - Personal history of in-situ neoplasm of skin
Deleted:
Deleted from Group 1:
- H81.41 Vertigo of central origin, right ear
- H81.42 Vertigo of central origin, left ear
- H81.43 Vertigo of central origin, bilateral
Code Description Change
- From G43.A0 - Cyclical vomiting, not intractable to G43.A0 - Cyclical vomiting, in migraine, not intractable
- From G43.A1 - Cyclical vomiting, intractable to G43.A1 - Cyclical vomiting, in migraine, intractable
- From M50.120 - Mid-cervical disc disorder, unspecified to M50.120 - Mid-cervical disc disorder, unspecified level
- From Z45.42 - Encounter for adjustment and management of neuropacemaker (brain) (peripheral nerve) (spinal cord) to Z45.42 - Encounter for adjustment and management of neurostimulator
09/12/19 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.
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- Creation of Uniform LCDs Within a MAC Jurisdiction
- Revisions Due To ICD-10-CM Code Changes
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10/08/2018
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R2
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10/23/18 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.
LCD revised to make editorial changes to B3d and H4 in the Coverage Indications, Limitations and/or Medical Necessity section. Added C15.3, C15.4 and C15.8, C88.0, C85.90, D32.9, E22.9, E23.7, E87.1, F80.1, G44.021, G62.89, H40.052, H40.053, H91.91-H91.93, H95.89, I60.9, I61.9, I63.20, I63.549, I63.9, I77.74, I82.C21, J36, J38.01, J38.02, J39.0, L02.811, M41.82, M43.22, M47.13, M50.03, M50.10, M50.20, M50.23, M54.2, Q40.9, R13.0, R13.10, R26.9, R29.898, R40.20, R43.9, S06.9X9A, S06.9X9D, S06.9X9S, S09.90XA, S09.90XD, S09.90XS, S19.9XXA, S19.9XXD, S19.9XXS. Moved F32.81 & F32.89 from Group 2 to Group 1, deleted all other Groups 2 and 3 codes as they are already listed in Group 1 and updated the CMS National Coverage Policy section.
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- Request for Coverage by a Practitioner (Part B)
- Other (Updated per CMS Guidelines.)
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10/08/2018
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R1
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09/06/2018 - 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.
This LCD is effective 10/08/18 to all allow for the required 45-day Notice period when a Draft policy finalizes. The Notice Period started on 8/23/18 and ends on 10/07/18. However, the Annual ICD-10 Code Update is effective 10/01/2018. The following codes were added and deleted to Group 1, Group 2 and revised from Group 1 will be effective on 10/01/2018.
Added to Group 1: C43.111, C43.112, C43.121, C43.122, C4A.111, C4A.112, C4A.121, C4A.122, C44.1121. C44.1122, C44.1191, C44.1192, C44.1221, C44.1222, C44.1291, C44.1292, C44.1921, C44.1922, C44.1991, C44.1992, D03.111, D03.112, D03.121, D03.122, D04.111, D04.112, D04.121, D04.122, D22.111, D22.112, D22.121, D22.122, D23.111, D23.112, D23.121, D23.122, E75.26, F53.0, F53.1, G51.31, G51.32, G51.33, H02.23A, H02.23B, H02.23C, H57.811, H57.812, H57.813, H57.819, H57.89, 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*
Added to Group 2: F53.0 and F53.1
Deleted from Group 1: C43.11, C43.12, C4A.11, C4A.12, C44.112, C44.119, C44.122, C44.129, C44.192, C44.199, D03.11, D03.12, D04.11, D04.12, D22.11, D22.12, D23.11, D23.12, F53, G51.3, H57.8, I63.8, T81.4XXA*, T81.4XXD* and T81.4XXS*
Deleted from Group 2: F53
Revised from Group 1: I63.333, I63.343, M50.01, M50.21, M50.31, M50.81 and M50.91
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- Revisions Due To ICD-10-CM Code Changes
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