07/01/2019
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R20
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12/06/2019: The content in the LCD was revised to be consistent with the new format supported by CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 13, Section 13.5.1.
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07/01/2019
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R19
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Revision Number: 9 Publication: June 2019 Connection LCR A/B2019-033
Explanation of Revision: Based on review of the LCD, typographical and formatting errors were corrected. The effective date of this revision is based on date of service.
07/01/2019: 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 LCD.
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04/01/2019
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R18
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Revision Number: 8 Publication: April 2019 Connection LCR A/B2019-028
Explanation of Revision: Based on CR 10901, the LCD was revised to remove all billing and coding and all language not related to reasonable and necessary provisions (“Bill Type Codes,” “Revenue Codes,” “CPT/HCPCS Codes,” “ICD-10 Codes that Support Medical Necessity,” “Documentation Requirements,” and “Utilization Guidelines” sections of the LCD) and place them into a newly created billing and coding article. Also, the LCD was revised to update Internet-Only Manual (IOM) references in the “CMS National Coverage Policy” section of the LCD. The effective date of this LCD revision is for claims processed on or after January 8, 2019, for dates of service on or after October 3, 2018. Additionally, based on CRs 11192, 11216, and 11232, the LCD billing and coding article was revised to add HCPCS codes C9141 and J7199 (Injection, factor viii, [antihemophilic factor, recombinant], pegylated-aucl [Jivi], 1 i.u). The effective date of this LCD revision is for dates of service on or after April 1, 2019.
04/01/2019: 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 LCD.
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- Other (Revisions due to Change Requests (CR) 11192, 11216, 11232, and 10901)
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01/01/2019
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R17
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Revision Number: 7 Publication: December 2018 Connection LCR A/B2019-001
Explanation of Revision: Annual 2019 HCPCS Update. The LCD was revised to add HCPCS codes J7170 and J7203 and corresponding ICD-10-CM diagnosis codes D66 and D67, respectively, in the “CPT/HCPCS Codes” and “ICD-10 Codes that Support Medical Necessity” sections of the LCD. Also, the “Sources of information” section of the LCD was updated. In addition, grammatical errors in the LCD were corrected. The effective date of this revision is based on date of service.
01/01/2019: 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 LCD.
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- Revisions Due To CPT/HCPCS Code Changes
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01/01/2018
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R16
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Revision Number: 6
Publication: December 2017 Connection
LCR A/B2018-001
Explanation of Revision: Explanation of Revision: Annual 2018 HCPCS Update. Removed HCPCS code J7199 (Afstyla) and deleted HCPCS code C9140 and replaced with HCPCS code J7210. In addition, added HCPCS code J7211. In addition, based on CR 10385 (January 2018 Integrated Outpatient Code Editior [I/OCE]), HCPCS code J7191 was changed from “Part A and Part B” to “Part B only” in the “CPT/HCPCS codes” section of the LCD as this code has a Part A status indicator “E2” (Not paid by Medicare when submitted on outpatient claims). Also, HCPCS code J7191 was removed from “Group 1 Paragraph:” under “ICD-10 Codes that Support Medical Necessity” section of the LCD and put in its own group. The effective date of this revision is based on date of service.
01/01/2018: 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.
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- Revisions Due To CPT/HCPCS Code Changes
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01/01/2017
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R15
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Revision Number: 5 Publication: December 2016 Connection LCR A/B2017-001
Explanation of Revision: Annual 2017 HCPCS Update. The LCD was revised to delete HCPCS codes C9137, C9138, and C9139. In addition, HCPCS codes C9140, J7202, J7207, J7209, J7179, and J7199 (Afstyla) were added. Also, HCPCS code J7199 was removed for Idelvion, Nuwiq, and Adynovate. Also, HCPCS code J7182 was changed from Part B only to Part A and B. The effective date of this revision is based on date of service.
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- Other (Correction HCPCS code J7182 was changed from Part B only to Part A and B.)
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01/01/2017
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R14
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Revision Number: 5 Publication: December 2016 Connection LCR A/B2017-001
Explanation of Revision: Annual 2017 HCPCS Update. The LCD was revised to delete HCPCS codes C9137, C9138, and C9139. In addition, HCPCS codes C9140, J7202, J7207, J7209, J7179, and J7199 (Afstyla) were added. Also, HCPCS code J7199 was removed for Idelvion, Nuwiq, and Adynovate. The effective date of this revision is based on date of service.
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- Revisions Due To CPT/HCPCS Code Changes
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10/01/2016
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R13
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Revision Number: 4 Publication: October 2016 Connection LCR A/B2016-101
Explanation of Revision: Based on the CMS October 2016 Updates, CR 9768 (Hospital OPPS), CR 9773 (ASC Payment System), and CR 9754 (I/OCE), HCPCS code C9139 replaced HCPCS code C9399 in the “CPT/HCPCS Codes” and “ICD-10 Codes that Support Medical Necessity” sections of the LCD. The effective date of this revision is based on date of service.
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07/11/2016
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R12
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7/14/16 - added clarification in paragraph sections of "CPT/HCPCS" code groups 8 and 9 for unlisted codes in groups 8 and 9.
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07/11/2016
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R11
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Revision Number: 3 Publication: July 2016 Connection LCR A/B2016-076
Explanation of Revision: Based on a reconsideration request and FDA approval, HCPCS codes J7199 (Idelvion) and C9399 (Idelvion) were added to the “CPT/HCPCS Codes” section of the LCD, and diagnosis code D67 was added to “ICD-10 Codes that Support Medical Necessity” section of the LCD. The “Sources of Information and Basis for Decision” section was also updated. The effective date of this revision is for claims processed on or after 07/11/2016, for dates of service on or after 3/4/2016.
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- Revisions Due To ICD-10-CM Code Changes
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04/01/2016
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R10
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04/26/16 CPT codes C9137 and C9138 were removed from the group six (6) paragraph section to the group six (6) code section.
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04/01/2016
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R9
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Revision Number: 2 Publication: April 2016 Connection LCR A/B2016-060
Explanation of Revision: Based on CR 9549 (April 2016 Update of the Hospital OPPS) and CR 9557 (April 2016 Update of the ASC Payment System), HCPCS codes C9137 and C9138 were added to the “CPT/HCPCS Codes” and “ICD-10 Codes that Support Medical Necessity” sections of the LCD. In addition, HCPCS code J7199 (Adynovate) and J7199 (Nuwiq) were added to the “CPT/HCPCS Codes” and “ICD-10 Codes that Support Medical Necessity” sections of the LCD. The effective date of this revision is based on date of service.
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- Revisions Due To CPT/HCPCS Code Changes
- Revisions Due To ICD-10-CM Code Changes
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01/01/2016
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R8
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The CPT code sections and ICD-10 diagnoses sections have been revised for further clarity, in regards to coverage.
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- Public Education/Guidance
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01/01/2016
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R7
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Typographical error corrected.
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01/01/2016
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R6
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Revision Number: 1 Publication: December 2015 Connection LCR A/B2016-009
Explanation of Revision: Annual 2016 HCPCS Update. HCPCS code Q9975 was deleted and replaced with HCPCS code J7205 and C9399/J7199 were removed and replaced with HCPCS code J7188. The effective date of this revision is based on date of service,
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- Public Education/Guidance
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10/01/2015
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R5
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08/24/2015 - - The language and/or ICD-10-CM diagnoses were updated to be consistent with the current ICD-9-CM LCD’s language and coding.
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- Provider Education/Guidance
- Public Education/Guidance
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10/01/2015
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R4
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04/20/2015 – The language and/or ICD-10-CM diagnoses were updated to be consistent with current LCD language and ICD-9-CM coding.
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- Provider Education/Guidance
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10/01/2015
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R3
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3/13/2015: The language and/or ICD-10-CM diagnoses were updated to be consistent with the current ICD-9-CM LCD’s language and coding.
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- Revisions Due To CPT/HCPCS Code Changes
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10/01/2015
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R2
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8/22/2014 - The language and/or ICD-10-CM diagnoses were updated to be consistent with the current ICD-9-CM LCD’s language and coding.
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- Revisions Due To ICD-10-CM Code Changes
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10/01/2015
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R1
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06/29/2014 - As a result of ICD-10 CM updates the following CPT/HCPCS code C9133 either the short description and/or the long description was changed.
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- Revisions Due To ICD-10-CM Code Changes
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