Persius/hicric huggingface dataset:
Billing and Coding: Bone Mass Measurement

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for Bone Mass
Measurement L39268.

**Coding Guidelines**

Procedure codes may be subject to National Correct Coding Initiative (NCCI)
edits or Outpatient Prospective Payment System (OPPS) packaging edits. Refer
to NCCI and OPPS requirements prior to billing Medicare.

For services requiring a referring/ordering physician, the name and NPI of the
referring/ordering physician must be reported on the claim.

All services/procedures performed on the same day for the same beneficiary by
the physician/provider should be billed on the same claim.

**Specific Coding Guidelines**

No separate payment for venography performed during the operative session may
be allowed and it should not be separately billed.

**Documentation Requirements**

The patient's medical record must contain documentation that fully supports
the medical necessity for services included within the related LCD. (See
"Indications and Limitations of Coverage.") This documentation includes, but
is not limited to, relevant medical history, physical examination, and results
of pertinent diagnostic tests or procedures.
Billing and Coding: Allogeneic Hematopoietic Cell Transplantation for Primary
Refractory or Relapsed Hodgkin's and Non-Hodgkin's Lymphoma with B-cell or
T-cell Origin

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for Allogeneic
Hematopoietic Cell Transplantation for Primary Refractory or Relapsed
Hodgkin's and Non-Hodgkin's Lymphoma with B-cell or T-cell Origin L39270 _._

The CMS National Coverage Determination (NCD 110.23) for Stem Cell
Transplantation describes nationally covered indications for stem cell
transplant, the details of which will not be repeated within this article.
This article describes additional locally covered indications for stem cell
transplant.

A pretransplant assessment, even accounting for institutional variations,
should establish the extent of disease and provide information about the
individual's comorbidities that are likely to impact outcomes.

The pretransplant evaluation should include a significant portion of the
following elements or documentation of the completion of the institution's
pre-established pre-transplant protocol, demonstrating the elements of that
protocol.

History and physical examination which includes:

  * Detailed history

  * Physical examination

  * All relevant laboratory studies 

  * A chest radiograph, an electrocardiogram, and a study of cardiac function

  * Pulmonary function test

  * Disease-specific restaging studies 

Further studies may be required depending on signs and symptoms.

It is expected that documentation of the pretransplant evaluation be included
in the medical record that supports the transplant's billing and be available
on request.

**PRETRANSPLANT COUNSELING**

This A/B MAC suggests the following:

  * Fertility preservation discussion, if relevant 

  * End-of-life and/or advance care planning 

  * Allogeneic Hematopoietic Cell Transplantation represents intense therapy for severe disease. Therefore, Palmetto GBA expects documentation relating the precise benefits and risks to a beneficiary in such a way that it is clear the discussion was tailored to the individual patient. Informed consent guidelines should show that patients have an accurate understanding of the risks of HCT. (Deeg & Sandmaier, Determining eligibility for allogeneic hematopoietic transplantation. _UpToDate._ 2022).
Response to Comments: MolDX: Lab-Developed Tests for Inherited Cancer
Syndromes in Patients with Cancer

The comment period for the MolDX: Lab-Developed Tests for Inherited Cancer
Syndromes DL38966 Local Coverage Determination (LCD) began on 05/20/2021 and
ended on 07/31/2021. The notice period for L38966 begins on 5/19/2022 and will
become effective on 7/3/2022.

The title of the LCD was revised from MolDX: Next-Generation Sequencing Lab-
Developed Tests for Inherited Cancer Syndromes to MolDX: Lab-Developed Tests
for Inherited Cancer Syndromes in Patients with Cancer.

The comments below were received from the provider community.
Response to Comments: MolDX: Lab-Developed Tests for Inherited Cancer
Syndromes in Patients with Cancer

The comment period for the MolDX: Lab-Developed Tests for Inherited Cancer
Syndromes DL39017 Local Coverage Determination (LCD) began on 05/20/2021 and
ended on 07/31/2021. The notice period for L39017 begins on 07/07/2022 and
will become effective on 8/21/2022.

The title of the LCD was revised from MolDX: Next-Generation Sequencing Lab-
Developed Tests for Inherited Cancer Syndromes to MolDX: Lab-Developed Tests
for Inherited Cancer Syndromes in Patients with Cancer.

The comments below were received from the provider community.
Response to Comments: MolDX: Molecular Biomarkers to Risk-Stratify Patients at
Increased Risk for Prostate Cancer

The comment period for the MolDX: Molecular Biomarkers to Risk-Stratify
Patients at Increased Risk for Prostate Cancer DL38985 Local Coverage
Determination (LCD) began on 05/20/2021 and ended on 07/03/2021. The notice
period for L38985 begins on 05/19/2022 and will become effective on
07/03/2022.

The title of the LCD was revised from MolDX: Biomarkers to Risk-Stratify
Patients at Increased Risk for Prostate Cancer to MolDX: Molecular Biomarkers
to Risk-Stratify Patients at Increased Risk for Prostate Cancer.

The comments below were received from the provider community.
Response to Comments: MolDX: Melanoma Risk Stratification Molecular Testing

The comment period for the MolDX: Melanoma Risk Stratification Molecular
Testing DL37725 Local Coverage Determination (LCD) began on 05/20/2021 and
ended on 07/03/2021. The notice period for L37725 begins on 05/19/2022 and
will become effective on 07/03/2022.

The comments below were received from the provider community.
Response to Comments: Mass Spectrometry (MS) Testing in Monoclonal Gammopathy
(MG)

As an important part of Medicare Local Coverage Determination (LCD)
development, National Government Services solicits comments from the provider
community and from members of the public who may be affected by or interested
in our LCDs. The purpose of the advice and comment process is to gain the
expertise and experience of those commenting.  
  
We would like to thank those who suggested changes to the Mass Spectrometry
(MS) Testing in Monoclonal Gammopathy (MG) LCD. The official notice period for
the final LCD begins on June 16, 2022 and the final determination will become
effective on August 1, 2022.
Response to Comments: Epidural Steroid Procedures Injections for Pain
Management

This article is the response to comments received by CGS Administrators, First
Coast Service Options, National Government Services (NGS), Novitas Solutions,
Palmetto GBA, and Wisconsin Physician Services (WPS) regarding the proposed
Epidural Procedures for Pain Management which was posted for comment on June
24, 2021 through August 24, 2021 and presented at the July 13, 2021 Open
Meeting for CGS Administrators. The proposed Epidural Steroid Injections for
Pain Management was posted for comment by Noridian Healthcare Solutions (NHS)
on February 10, 2022 through March 26, 2022 and presented at the February 24,
2022 Open Meeting for NHS. All comments were reviewed, and the responses are
provided in this document. Comments on the same topic are grouped.
Response to Comments: MolDX: Melanoma Risk Stratification Molecular Testing

The comment period for the MolDX: Melanoma Risk Stratification Molecular
Testing DL38016 Local Coverage Determination (LCD) began on 06/24/2021 and
ended on 08/07/2021. The notice period for L38016 begins on 05/19/2022 and
will become effective on 07/03/2022.

The comments below were received from the provider community.
Response to Comments: Nebulizers  DL33370

During the 45-day comment period, which was open from September 30, 2021
through November 13, 2021, the DME MACs received comments from four
commenters.

**NOTE:** _DME MACs review all submitted comments and may choose to
consolidate similar thematic comments or redact or withhold certain
submissions (or portions thereof) such as those containing private or
proprietary information, inappropriate language or duplicate/near duplicate
submissions. As a result, there may be a discrepancy between the number of
comments in the article and the actual number of comments received._

Introduction to Responses

The DME MACs appreciate the comments received from stakeholders during the
open comment period for the proposed Nebulizers Local Coverage Determination
(LCD) (DL33370).

Pursuant to the CMS Program Integrity Manual (CMS Pub. 100-08) Chapter 13:  
 _In conducting a review, MACs shall use the available evidence of general
acceptance by the medical community, such as published original research in
peer-reviewed medical journals, systematic reviews and meta-analyses,
evidence-based consensus statements and clinical guidelines._

Accordingly, the final policy and our response to comments are based on the
best currently available published clinical evidence, to support optimal
health outcomes in Medicare beneficiaries.
Billing and Coding: eVox System and Other Electroencephalograph Testing for
Memory Loss

  
eVox, BrainView NeuralScan and VoxNeuro are Class II medical devices cleared
by the [U.S. Food & Drug Administration
(FDA)](https://www.fda.gov/MedicalDevices/default.htm) that acquire, display,
and store the electrical activity of a patient's brain, including
electroencephalograph (EEG) and event-related potentials (ERPs), by placing
two or more electrodes on the head. These devices map areas of the brain and
measure brain activity. Using analytical software the test findings are placed
into interpretable results assisting the physician in making a diagnosis and
decision about a patient's brain function.  
  
First Coast has seen the eVox System billed to Medicare using the following
Current Procedural Terminology (CPT) codes 92650, 92653, 95816, 95930, 95957
and 96146.  
  
 **Coding Guidance  
  
** CPT codes 92650, 92653, 95816, 95930, 95957 and 96146 represent separate
services for digital analysis of EEG, EEG recording, and visual and auditory
evoked potential testing. The eVox System and similar tests describe a panel
of tests that should be billed using the unlisted neurological or
neuromuscular diagnostic procedure code. The panel of tests does not
accurately reflect the testing, the work units nor the inherent training
described by the CPT codes listed above. Therefore, it is incorrect coding to
bill the individual CPT codes listed above when performing the eVox System or
other electroencephalograph testing for memory loss.  
  
When billing for eVox System, BrainView NeuralScan, VoxNeuro or similar
systems CPT code 95999 should be reported on the claim with one unit of
service. The term for the device (e.g., eVox System, BrainView Neural Scan
System, VoxNeuro, etc.) should be reported in the Remarks area of the claim
for Part A and the Narrative area of the claim for Part B.  
  
 **Documentation Requirements**

  1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.
Response to Comments: Multiplex Gastrointestinal Pathogen Panel (GPP) Tests
for Acute Gastroenteritis (AGE)

As an important part of Medicare Local Coverage Determination (LCD)
development, National Government Services solicits comments from the provider
community and from members of the public who may be affected by or interested
in our LCDs. The purpose of the advice and comment process is to gain the
expertise and experience of those commenting.  
  
We would like to thank those who suggested changes to the Multiplex
Gastrointestinal Pathogen Panel (GPP) Tests for Acute Gastroenteritis (AGE).
The official notice period for the final LCD begins on June 16, 2022 and the
final determination will become effective on August 1, 2022.
Response to Comments: Category III Codes-(DL35490)

This article summarizes the comments WPS received for Draft Local Coverage
Determinations (LCD) Category III Codes DL35490. Thank you for the comments.
Billing and Coding: MolDX: Prognostic and Predictive Molecular Classifiers for
Bladder Cancer

The information in this article contains billing, coding, or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Prognostic
and Predictive Molecular Classifiers for Bladder Cancer DL38576.

To report a service, please submit the following claim information:

  * Select the appropriate CPT code 
  * Enter 1 unit of service (UOS)
  * Enter the appropriate DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part B claim field/types: 
    * Loop 2400 or SV101-7 for the 5010A1 837P
    * Box 19 for paper claim
  * Enter the appropriate DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types: 
    * Line SV202-7 for 837I electronic claim
    * Block 80 for the UB04 claim form
  * Select the appropriate ICD-10-CM code
Billing and Coding: MolDX: Molecular Assays for the Diagnosis of Cutaneous
Melanoma

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Molecular
Assays for the Diagnosis of Cutaneous Melanoma.

Please submit the following claim information:

  * Regarding the myPathMelanoma assay: 
    * Select CPT code 81479 for dates of service prior to 7/1/2019
    * Select proprietary CPT code 0090U for dates of service on or after 7/1/2019
  * Regarding other molecular assays for the diagnosis of cutaneous melanoma: 
    * Select CPT code 81479 if there is not an applicable CPT or PLA code listed below
  * Only 1 test may be billed per patient per melanocytic lesion.
  * Enter 1 unit of service (UOS)
  * Enter the appropriate DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part B claim field/types:
    * Loop 2400 or SV101-7 for the 5010A1 837P
    * Box 19 for paper claim
  * Enter the appropriate DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types:
    * Line SV202-7 for 837I electronic claim
    * Block 80 for the UB04 claim form
  * Select the appropriate ICD-10-CM code
Billing and Coding: MolDX: Molecular Assays for the Diagnosis of Cutaneous
Melanoma

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Molecular
Assays for the Diagnosis of Cutaneous Melanoma.

Please submit the following claim information:

  * Regarding the myPath Melanoma assay: 
    * Select CPT code 81479 for dates of service prior to 7/1/2019
    * Select proprietary CPT code 0090U for dates of service on or after 7/1/2019
  * Regarding other molecular assays for the diagnosis of cutaneous melanoma: 
    * Select CPT code 81479 if there is not an applicable CPT or PLA code listed below
  * Only 1 test may be billed per patient per melanocytic lesion.
  * Enter 1 unit of service (UOS)
  * Enter the appropriate DEX Z-Code identifier adjacent to the CPT code in the comment/narrative field for the following Part B claim field/types:
    * Loop 2400 or SV101-7 for the 5010A1 837P
    * Box 19 for paper claim
  * Enter the appropriate DEX Z-Code identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types:
    * Line SV202-7 for 837I electronic claim
    * Block 80 for the UB04 claim form
  * Select the appropriate ICD-10-CM code
Billing and Coding: MolDX: Prognostic and Predictive Molecular Classifiers for
Bladder Cancer

The information in this article contains billing, coding, or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Prognostic
and Predictive Molecular Classifiers for Bladder Cancer DL38586.

To report a service, please submit the following claim information:

  * Select the appropriate CPT code
  * Enter 1 unit of service (UOS)
  * Enter the appropriate DEX-Z-codeTM identifier adjacent to the CPTcode in the comment/narrative field for the following Part B claim field/types: 
    * Loop 2400 or SV101-7 for the 5010A1 837P
    * Box 19 for paper claim
  * Enter the appropriate DEX-Z-codeTM identifier adjacent to the CPTcode in the comment/narrative field for the following Part A claim field/types: 
    * Line SV202-7 for 837I electronic claim
    * Block 80 for the UB04 claim form
  * Select the appropriate ICD-10-CM code
Response to Comments: Minimally Invasive Surgical (MIS) Fusion of the
Sacroiliac Joint (SIJ)

The comment period for the Minimally Invasive Surgical (MIS) Fusion of the
Sacroiliac Joint (SIJ) DL39025 Local Coverage Determination (LCD) began on
7/22/21 and ended on 9/4/21. The notice period for L39025 begins on 6/2/22 and
will become effective on 7/17/22.
Response to Comments: MolDX: Molecular Biomarkers to Risk-Stratify Patients at
Increased Risk for Prostate Cancer

The comment period for the MolDX: Biomarkers to Risk-Stratify Patients at
Increased Risk for Prostate Cancer DL38997 Local Coverage Determination (LCD)
began on 06/24/2021 and ended on 08/07/2021. The notice period for L38985
begins on 06/02/2022 and will become effective on 07/17/2022.

The title of the LCD was revised from MolDX: Biomarkers to Risk-Stratify
Patients at Increased Risk for Prostate Cancer to MolDX: Molecular Biomarkers
to Risk-Stratify Patients at Increased Risk for Prostate Cancer.

The comments below were received from the provider community.
Response to Comments: Erythropoiesis Stimulating Agents

The comment period for the Erythropoiesis Stimulating Agents DL39237 Local
Coverage Determination (LCD) began on 2/17/22 and ended on 4/2/22. The notice
period for L39237 begins on 6/9/22 and will become effective on 7/24/22.

The comments below were received from the provider community.
Response to Comments: MolDX: Lab-Developed Tests for Inherited Cancer
Syndromes in Patients with Cancer (DL39040)

The comment period for the MolDX: Lab-Developed Tests for Inherited Cancer
Syndromes DL39040 Local Coverage Determination (LCD) began on 05/20/2021 and
ended on 07/31/2021. The notice period for L39040 begins on 5/19/2022 and will
become effective on 7/3/2022.

The title of the LCD was revised from MolDX: Next-Generation Sequencing Lab-
Developed Tests for Inherited Cancer Syndromes to MolDX: Lab-Developed Tests
for Inherited Cancer Syndromes in Patients with Cancer.

The comments below were received from the provider community.
Response to Comments: MolDX: Melanoma Risk Stratification Molecular Testing

The comment period for the MolDX: Melanoma Risk Stratification Molecular
Testing DL38018 Local Coverage Determination (LCD) began on 05/20/2021 and
ended on 07/03/2021. The notice period for L37725 begins on 05/19/2022 and
will become effective on 07/03/2022.

The comments below were received from the provider community.
Response to Comments: MolDX: Molecular Biomarkers to Risk-Stratify Patients at
Increased Risk for Prostate Cancer

The comment period for the MolDX: Molecular Biomarkers to Risk-Stratify
Patients at Increased Risk for Prostate Cancer DL39042 Local Coverage
Determination (LCD) began on 05/20/2021 and ended on 07/03/2021. The notice
period for L39042 begins on 05/19/2022 and will become effective on
07/03/2022.

The title of the LCD was revised from MolDX: Biomarkers to Risk-Stratify
Patients at Increased Risk for Prostate Cancer to MolDX: Molecular Biomarkers
to Risk-Stratify Patients at Increased Risk for Prostate Cancer.

The comments below were received from the provider community.
Billing and Coding: MolDX: Molecular Testing for Detection of Upper
Gastrointestinal Metaplasia, Dysplasia, and Neoplasia

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Molecular
Testing for Detection of Upper Gastrointestinal Metaplasia, Dysplasia, and
Neoplasia.

To receive a denial, please submit the following claim information:

  * Select appropriate CPT code
  * Enter 1 unit of service (UOS)
  * Enter the appropriate DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part B claim field/types: 
    * Loop 2400 or SV101-7 for the 5010A1 837P
    * Box 19 for paper claim
  * Enter the appropriate DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types: 
    * Line SV202-7 for 837I electronic claim
    * Block 80 for the UB04 claim form
  * Select the appropriate ICD-10-CM code
Response to Comments: Upper Gastrointestinal Endoscopy and Visualization

The comment period for the Upper Gastrointestinal Endoscopy and Visualization
DL34434 Local Coverage Determination (LCD) began on 3/31/22 and ended on
5/14/22. The notice period for L34434 begins on 6/30/22 and will become
effective on 8/14/22. No comments were received from the provider community.
Response to Comments: MolDX: Lab-Developed Tests for Inherited Cancer
Syndromes in Patients with Cancer

The comment period for the MolDX: Lab-Developed Tests for Inherited Cancer
Syndromes DL38972 Local Coverage Determination (LCD) began on 05/20/2021 and
ended on 07/31/2021. The notice period for L38972 begins on 06/23/2022 and
will become effective on 08/08/2022.

The title of the LCD was revised from MolDX: Next-Generation Sequencing Lab-
Developed Tests for Inherited Cancer Syndromes to MolDX: Lab-Developed Tests
for Inherited Cancer Syndromes in Patients with Cancer.

The comments below were received from the provider community.
Response to Comments: MolDX: Lab-Developed Tests for Inherited Cancer
Syndromes in Patients with Cancer

The comment period for the MolDX: Lab-Developed Tests for Inherited Cancer
Syndromes DL38974 Local Coverage Determination (LCD) began on 05/20/2021 and
ended on 07/31/2021. The notice period for L38974 begins on 06/23/2022 and
will become effective on 08/08/2022.

The title of the LCD was revised from MolDX: Next-Generation Sequencing Lab-
Developed Tests for Inherited Cancer Syndromes to MolDX: Lab-Developed Tests
for Inherited Cancer Syndromes in Patients with Cancer.

The comments below were received from the provider community.