Persius/hicric huggingface dataset:
Response to Comments: Osteopathic Manipulative Treatment 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.  
  
Thank you for the overwhelming response during the period of Comment for the
NGS policy draft Osteopathic Manipulative Treatment. By the close of the
Comment period on Aug. 13th, NGS had received more than 2400 individual
comments, and a much appreciated, overarching, set of comments and proposed
revision from the American Osteopathic Association.  
  
The official notice period for the final LCD begins on 09/16/2016, and the
final determination will become effective on 11/01/2016.
Response to Comments: Molecular Pathology Procedures 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 draft Molecular
Pathology Procedures LCD. The official notice period for the final LCD begins
on October 13, 2016, and the final determination will become effective on
December 1, 2016.
Billing and Coding: Retroperitoneal Ultrasound

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for Retroperitoneal
Ultrasound L34577.

A full (complete) or limited abdominal ultrasound (US) (CPT 76700, 76705,
76706*), views all structures in the abdomen including those in the
retroperitoneal area. Frequently when a retroperitoneal US is performed
findings encountered during the exam may warrant that the exam be expanded to
become a full abdominal study.  
  
It is expected that CPT 76770, 76775, 76776 will only be billed when the exam
has been limited to retroperitoneal structures. Exams that include structures
other than or in addition to, those listed above should be billed as a full
(complete) or appropriately limited abdominal US (CPT 76700, 76705, 76706*).  
  
It is not appropriate to bill for both a retroperitoneal US study AND a
complete (or limited) abdominal US when a retroperitoneal US study is expanded
to include organs and structures outside the retroperitoneum.

**Utilization Guidelines**

If the physical exam has primary findings for the involvement of non-
retroperitoneal structures/organs (gallbladder, liver, spleen, common bile
duct, etc.), even though it may be necessary to visualize retroperitoneal
structures in the course of the procedure, a full abdominal US would be
required in most cases to be diagnostic, and that is the procedure that should
be performed and billed.
Response to Comments: Serum Magnesium Noridian's Response to Provider
Recommendations (for comment period ending 08/08/2016)
Response to Comments: Serum Magnesium Noridian's Response to Provider
Recommendations (for comment period ending 08/08/2016).
Response to Comments: Vitamin D Assay Testing Noridian's Response to Provider
Recommendations for Vitamin D Assay Testing (for comment period ending
08/08/2016).
Response to Comments: Genomic Sequence Analysis Panels in the Treatment of
Acute Myelogenous Leukemia (AML) 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 Genomic Sequence
Analysis Panels in the Treatment of Acute Myelogenous Leukemia (AML) LCD. The
official notice period for the final LCD begins on December 15, 2016 and the
final determination will become effective on February 1, 2017.
Response to Comments: Polysomnography and Other Sleep Studies (L36839) This
article summarizes the comments WPS received for Draft Local Coverage
Determinations (LCD) Polysomnography and Other Sleep Studies, DL36839. Thank
you for the comments.
Response to Comments: Botulinum Toxin Types A and B Noridian's Response to
Provider Recommendations for Botulinum Toxin Types A and B (for comment period
ending 08/08/2016)
Response to Comments: MolDX: Molecular Diagnostic Tests (MDT) (L36807) This
article summarizes the comments WPS received for Draft Local Coverage
Determinations (LCD) MolDX: Molecular Diagnostic Tests (MDT)(L36807). Thank
you for the comments.
Response to Comments: MolDX: Genetic Testing for BCR-ABL Negative
Myeloproliferative Disease (L36815) This article summarizes the comments WPS
received for Draft Local Coverage Determinations (LCD) MolDX: Genetic Testing
for BCR-ABL Negative Myeloproliferative Disease (L36815). Thank you for the
comments.
Response to Comments: MolDX: NRAS Genetic Testing (L36797) This article
summarizes the comments WPS received for Draft Local Coverage Determinations
(LCD) MolDX: NRAS Genetic Testing. Thank you for the comments.
Response to Comments: MolDX: Breast Cancer Assay: Prosigna (L36811). This
article summarizes the comments WPS received for Draft Local Coverage
Determinations (LCD) MolDX: Breast Cancer Assay: Prosigna (L36811). Thank you
for the comments.
Response to Comments: Special Histochemical Stains and Immunohistochemical
Stains (L36805) This article summarizes the comments WPS received for Draft
Local Coverage Determinations (LCD) Special Histochemical Stains and
Immunohistochemical Stains. Thank you for the comments.
Response to Comments: Peripheral Nerve Blocks 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 LCD for Peripheral
Nerve Blocks. The official notice period for the final LCD begins on March 16,
2017 and the final determination will become effective on May 1, 2017.
Response to Comments: GlycoMark Testing for Glycemic Control

The following are comments received by CGS Administrators during the open
comment period, 11/16/2016 to 01/03/2017,  for DL36906 GlycoMark Testing for
Glycemic Control.
Response to Comments: Polysomnography and Other Sleep Studies CGS
Administrators did not receive any comments for draft policy DL36902
Polysomnography and Other Sleep Studies during the comment period.
Response to Comments: Nerve Conduction Studies and Electromyography

The following are comments received by CGS Administrators during comment
period, 11/16/2016 to 01/03/2017, for DL35897 Nerve Conduction Studies and
Electromyography.
Response to Comments: MolDX: HLA-DQB1*06:02

CGS Administrators received no comments during the open comment period,
11/16/2016 to 01/03/2017, for draft MolDX: HLA-DQB1*06:02Testing for
Narcolepsy.
Response to Comments: MolDX - CDD: Oncotype DX  Breast Cancer for DCIS
(Genomic Health )

CGS Administrators received no comments during the open comment period,
11/16/2016 to 01/03/2017,  for draft policy DL36951 MolDX - CDD: Oncotype DX 
Breast Cancer for DCIS (Genomic Health TM).
Response to Comments: Bladder/Urothelial Tumor The following address comments
received by Noridian Healthcare Solutions on draft policies JE-DL36678 and JF-
DL36680. as the policy was created to create an uniform LCD with other MACs
CGS is attaching and will update their policy based on responses received.
Response to Comments: MolDX: APC and MUTYH Gene The comment period for the
MolDX: APC and MUTYH Gene Testing (LCD) DL36910 began on 11/16/2016 and ended
on 01/03/2017. Comments were received from  
the provider community. The notice period begins on 01/26/2017 and ends
03/12/2017 . The LCD becomes final on 03/13/2017 .  
  
The following also includes comments received by Noridian Healthcare
Solutions, LLC JE-DL36882, JF -DL36884 and Palmetto DL36827.
Response to Comments: MolDX-CDD: Percepta The comment period for the MolDX:
APC and MUTYH Gene Testing (LCD) DL36908 began on 11/16/2016 and ended on
01/03/2017. Comments were received from  
the provider community. The notice period begins on 01/26/2017 and ends
03/12/2017 . The LCD becomes final on 03/13/2017.
Response to Comments: Bladder/Urothelial Tumor Markers Noridian's Response to
Provider Recommendations (for comment period ending 08/08/16).
Billing and Coding: MolDX: VEGFR2 Tests

Vascular endothelial growth factor, subtype 2, (VEGFR2) receptor has been
found to be oncogenic. Current studies have targeted VEGFR2 as a potential
therapeutic option. However, at present there is insufficient evidence to
establish a clear association between VEGFR2 mutations and treatment response.
Therefore, the MolDX Team has determined VEGFR2 testing is a statutorily
excluded service. MolDX will also deny panels of tests that include the VEGFR2
receptor.  
  
To receive a VEGFR2 service denial, please submit the following claim
information:

    * CPT code 81479
    * An Advance Beneficiary Notice (ABN) is not required for statutorily excluded services.
      * For a voluntary issued ABN, append with GX modifier
      * To indicate a valid ABN is on file for a known statutorily excluded service, append with a GY modifier
    * 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
      * Item 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
Billing and Coding: MolDX: VEGFR2 Tests

Vascular endothelial growth factor, subtype 2, (VEGFR2) receptor has been
found to be oncogenic. Current studies have targeted VEGFR2 as a potential
therapeutic option. However, at present there is insufficient evidence to
establish a clear association between VEGFR2 mutations and treatment response.
Therefore, the MolDX Team has determined VEGFR2 testing is a statutorily
excluded service. MolDX will also deny panels of tests that include the VEGFR2
receptor.  
  
To receive a VEGFR2 service denial, please submit the following claim
information:

    * CPT code 81479
    * An Advance Beneficiary Notice (ABN) is not required for statutorily excluded services.
      * For a voluntary issued ABN, append with GX modifier
      * To indicate a valid ABN is on file for a known statutorily excluded service, append with a GY modifier
    * Select the appropriate diagnosis for the patient
    * 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
      * Item 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
Response to Comments: MolDX- CDD: ProMark Risk Score Noridian's response to
provider recommendations for comment period ending 08/08/2016.
Response to Comments: Trigger Point Injections Noridian's Response to Provider
Recommendations for Trigger Point Injections (for comment period ending
12/15/2016)
Response to Comments: Visual Electrophysiology Testing 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 Visual
Electrophysiology Testing LCD. The official notice period for the final LCD
begins on December 29, 2016 and the final determination will become effective
on March 16, 2017.
Billing and Coding: Abbreviated Daytime Sleep Study (e.g. PAP-NAP) An
abbreviated daytime sleep study (PAP NAP) has been used by some to address
poor compliance and enhance individual comfort and tolerance of CPAP/BiPAP.
PAP NAP combines psychological and physiological treatments into one procedure
during an abbreviated daytime nap session (100-120 minutes). Sleep technicians
employ various coaching and monitoring techniques including mask and pressure
desensitization, emotion focused therapy to overcome aversive responses to
CPAP, mental imagery to divert the individuals attention from the sensations
associated with CPAP and physiological exposure to CPAP.  
  
An Abbreviated daytime sleep study (PAP-NAP) used as a supplement to standard
sleep studies for all indications, including but not limited to, the following
are considered integral to the primary procedure and (are) not separately
reimbursable.  

  

  * correcting non-compliance, or improving compliance with prescribed CPAP
  

  * decreasing anxiety/claustrophobia associated with CPAP
  

  * patient education
  

  * mask and pressure desensitization
  

  * cognitive behavioral therapy (CBT)
  

  
Limited data from a single study of PAP-NAP is insufficient evidence to form
conclusions on the efficacy of this approach in improving compliance with
CPAP. No professional guidelines currently recommend use of PAP NAP as a
compliance enhancement.  
  
 **Split Studies**  
It is not appropriate to bill diagnostic and titration studies separately when
performing a split night study. This is considered one service.  
  
 **Sources of Information**  

  

  1. BlueCross BlueShield Association. Medical Policy Reference Manual. (11:2015). _Diagnosis and medical management of obstructive sleep apnea syndrome._ (2.01.18). Retrieved June 29, 2016 from BlueWeb. (61 articles and/or guidelines reviewed)
  

  2. Centers for Medicare & Medicaid Services. CMS.gov. _NCD for sleep testing for obstructive sleep apnea (OSA) (240.4.1)._ Retrieved June 29, 2016 from [MCPM](https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=330&ncdver=1&DocID=240.4.1&from2=search.asp&bc=gAAAAAgAAAAAAA%3d%3d&.)
  

  3. Krakow, B., Ulibarri, V., Melendrez, D., Kikta, S., Togami, L., & Haynes, P. (2008). A daytime, abbreviated cardio-respiratory sleep study (CPT 95807-52) to acclimate insomnia patients with sleep disordered breathing to positive airway pressure (PAP-NAP). _Journal of Clinical Medicine,_ 4 (3), 212-222. (Level 4 evidence)
  

  4. FREQUENTLY ASKED QUESTIONS ABOUT SLEEP CODING _American Academy of Sleep Medicine,_ March, 2014
Billing and Coding: MolDX: STAT3 Gene Testing

STAT3 gene testing may be performed during the diagnosis of Autosomal Dominant
Hyper IgE Syndrome (AD-HIES). Since management is not determined by the
presence or absence of a STAT3 mutation in patients with a probable clinical
diagnosis, the MolDX Contractor has determined STAT3 analysis is a statutorily
excluded test.  
  
To receive a STAT3 analysis service denial, please submit the following claim
information:

  * CPT code 814058 - STAT3, targeted sequence analysis
  * An Advance Beneficiary Notice (ABN) is not required for statutorily excluded services.
    * For a voluntary issued ABN, append with GX modifier
    * To indicate a valid ABN is on file for a known statutorily excluded service, append with a GY modifier
  * Select the appropriate diagnosis for the patient
  * 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
    * Item 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
Billing and Coding: MolDX: STAT3 Gene Testing

STAT3 gene testing may be performed during the diagnosis of Autosomal Dominant
Hyper IgE Syndrome (AD-HIES). Since management is not determined by the
presence or absence of a STAT3 mutation in patients with a probable clinical
diagnosis, the MolDX Contractor has determined STAT3 analysis is a statutorily
excluded test.  
  
To receive a STAT3 analysis service denial, please submit the following claim
information:

  * CPT code 81405 - STAT3, targeted sequence analysis
  * An Advance Beneficiary Notice (ABN) is not required for statutorily excluded services. 
    * For a voluntary issued ABN, append with GX modifier
    * To indicate a valid ABN is on file for a known statutorily excluded service, append with a GY modifier
  * Select the appropriate diagnosis for the patient
  * 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
    * Item 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
Billing and Coding: MolDX: TP53 Gene Tests

TP53 gene testing may be performed during the diagnosis of Li-Fraumeni
syndrome (LFS), a cancer predisposition syndrome associated with the
development of specific tumors. Clinical symptoms and diagnosis usually occur
prior to Medicare eligibility and carrier testing is not a covered benefit.  
  
To receive a TP53 gene sequencing service denial, please submit the following
claim information:

  * Select the appropriate CPT code
  * An Advance Beneficiary Notice (ABN) is not required for statutorily excluded services.  

    * For a voluntary issued ABN, append with GX modifier
    * To indicate a valid ABN is on file for a known statutorily excluded service, append with a GY modifier.
  * Select the appropriate diagnosis for the patient
  * 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
    * Item 19 for paper claim
  * Enter 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
Billing and Coding: MolDX: TP53 Gene Tests

TP53 gene testing may be performed during the diagnosis of Li-Fraumeni
syndrome (LFS), a cancer predisposition syndrome associated with the
development of specific tumors. Clinical symptoms and diagnosis usually occur
prior to Medicare eligibility and carrier testing is not a covered benefit.  
  
To receive a TP53 gene sequencing service denial, please submit the following
claim information:

  * Select the appropriate CPT code
  * An Advance Beneficiary Notice (ABN) is not required for statutorily excluded services.  

    * For a voluntary issued ABN, append with GX modifier
    * To indicate a valid ABN is on file for a known statutorily excluded service, append with a GY modifier
  * Select the appropriate diagnosis for the patient
  * 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
    * Item 19 for paper claim
  * Enter 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
Response to Comments: Injections - Tendon, Ligament, Ganglion Cyst, Tunnel
Syndromes and Morton's Neuroma Noridian's response to provider recommendations
for comment period ending 12/15/2016.
Response to Comments: Polysomnography and Other Sleep Studies Noridian's
Response to Provider Recommendations for Polysomnography and Other Sleep
Studies (for comment period ending 12/15/2016)  
  
There were several comments regarding this policy. Many dealt with
credentialing of some sort. Similar comments will be grouped.
Response to Comments: GlycoMark Testing for Glycemic Control

Noridian's response to provider recommendations for comment period ending
12/15/2016.
Billing and Coding: Peripheral Nerve Stimulation

The following billing and coding guidance is to be used with its associated
Local Coverage Determination.

Noridian has found the current peer-reviewed data is insufficient to warrant
the medical necessity of coverage for Peripheral Nerve Field Stimulation
(PNFS), also known as Peripheral Subcutaneous Field Stimulation (PSFS) for any
condition. Therefore, this service will not be covered for any condition.  
  
To bill for denial, providers must bill CPT code 64999 for both the trial and
permanent insertion of the electrode array when billing for these procedures
and report the following information.  
  
 _Part B claims_

  * Enter 1 units of service (UOS)
  * Enter Peripheral Nerve Field Stimulation, PNFS, Peripheral Subcutaneous Field Stimulation, or PSFS adjacent to the CPT code 64999 and whether the procedure is for a permanent or trial in the comment/narrative field/types:  

    * Loop 2400 or SV101-7 for the 5010A1 837P
    * Item 19 for paper claim

_Part A claims_

  * Enter 1 UOS
  * Enter Peripheral Nerve Field Stimulation, PNFS, Peripheral Subcutaneous Field Stimulation, or PSFS adjacent to the CPT code 64999 and whether the procedure is for a permanent or trial in the comment/narrative field/types:  

    * Line SV02-7 for 837 in electronic claim
    * Block 80 on the UB04 claim form
Billing and Coding: Peripheral Nerve Stimulation

The following billing and coding guidance is to be used with its associated
Local Coverage Determination.

Noridian has found the current peer-reviewed data is insufficient to warrant
the medical necessity of coverage for Peripheral Nerve Field Stimulation
(PNFS), also known as Peripheral Subcutaneous Field Stimulation (PSFS) for any
condition. Therefore, this service will not be covered for any condition.  
  
To bill for denial, providers must bill CPT code 64999 for both the trial and
permanent insertion of the electrode array when billing for these procedures
and report the following information.  
  
 _Part B claims_

  * Enter 1 units of service (UOS)
  * Enter Peripheral Nerve Field Stimulation, PNFS, Peripheral Subcutaneous Field Stimulation, or PSFS adjacent to the CPT code 64999 and whether the procedure is for a permanent or trial in the comment/narrative field/types:  

    * Loop 2400 or SV101-7 for the 5010A1 837P
    * Item 19 for paper claim

_Part A claims_

  * Enter 1 UOS
  * Enter Peripheral Nerve Field Stimulation, PNFS, Peripheral Subcutaneous Field Stimulation, or PSFS adjacent to the CPT code 64999 and whether the procedure is for a permanent or trial in the comment/narrative field/types:  

    * Line SV02-7 for 837I electronic claim
    * Block 80 on the UB04 claim form
Response to Comments: Visual Electrophysiology Testing (L37015) This article
summarizes the comments WPS received for Draft Local Coverage Determinations
(LCD) Visual Electrophysiology Testing, DL37015. Thank you for the comments.
Response to Comments: MolDX: MGMT Promoter Methylation Analysis (DL37001).
This article summarizes the comments WPS received for Draft Local Coverage
Determinations (LCD) MolDX: MGMT Promoter Methylation Analysis (DL37001).
Thank you for the comments.
Response to Comments: MolDX: HLA-DQB1*06:02 Testing for Narcolepsy (DL37003).
This article summarizes the comments WPS received for Draft Local Coverage
Determinations (LCD) MolDX: HLA-DQB1*06:02 Testing for Narcolepsy (DL37003).
Thank you for the comments.