Persius/hicric huggingface dataset:
Billing and Coding: Screening for Cervical Cancer with Human Papillomavirus
(HPV)

It has come to our attention that services submitted for screening for
cervical cancer with Human Papillomavirus (HPV) Testing have been reported
incorrectly. This Billing and Coding Article provides billing and coding
guidance for these services.  
  
**Coding Guidance**

**Notice:** It is not appropriate to bill Medicare for services that are not
covered as if they are covered. When billing for non-covered services, use the
appropriate modifier.

Consistent with National Coverage Determination (NCD) 210.2.1 screening HPV
services are to be billed with Healthcare Common Procedure Coding System
(HCPCS) code G0476. These services require dual diagnosis codes. The primary
International Statistical Classification of Diseases and Related Health
Problems, 10th revision, (ICD-10) code Z11.51 must be reported along with one
of the following secondary ICD-10-CM diagnosis codes: Z01.411 or Z01.419.  
  
It is incorrect to report these screening services with Current Procedural
Terminology (CPT) code 87624 [Infectious agent detection by nucleic acid (DNA
or RNA); Human Papillomavirus (HPV), high-risk types].  
  
Please refer to NCD 210.2.1 for complete information on screening for cervical
cancer with Human Papillomavirus (HPV).
Billing and Coding: Computed Tomography Cerebral Perfusion Analysis (CTP)

**Documentation Requirements**

  
The patient's medical record should include but is not limited to:  
 The assessment of the patient by the ordering provider as it relates to the
complaint of the patient for that visit,  
 Relevant medical history  
 Results of pertinent tests/procedures  
 Signed and dated office visit record/operative report (Please note that all
services ordered or rendered to Medicare beneficiaries must be signed.)  
 Performance of the study in a stoke center

Effective 12/12/2021 please append computed tomography cerebral perfusion
analysis identified with CPT 0042T with the KX modifier to attest the CTP
analysis was performed in a certified stroke center.

If the service is provided in the emergency room (POS 23) the ER must be part
of the certified stroke center to qualify for coverage.

The patient's medical record must contain documentation that fully supports
the medical necessity for services included within this 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.

Each claim must be submitted with ICD-10-CM codes that reflect the condition
of the patient and indicate the reason(s) for which the service was performed.
Claims submitted without ICD-10-CM codes will  
be returned.

The documentation of the study requires a formal written report, with clear
identifying demographics, the name of the interpreting provider, the reason
for the tests, an interpretive report and copies of images. The computerized
image reconstruction data should also be maintained.

Documentation must be available to Medicare upon request.
Response to Comments: Magnetic-Resonance-Guided Focused Ultrasound Surgery
(MRgFUS) for Essential Tremor

First Coast Service Options, Inc. (First Coast) received comments from the
INSIGHTEC and American Association of Neurological Surgeons (AANS), the
Congress of Neurological Surgeons (CNS) and the American Society for
Stereotactic and Functional Neurosurgery (ASSFN) from within and outside the
Medicare Administrative Contractor (MAC) Jurisdiction N (JN) for Florida,
Puerto Rico and the United States Virgin Islands, for the Proposed Local
Coverage Determination (LCD) DL38506/A57884 Magnetic-Resonance-Guided Focused
Ultrasound Surgery (MRgFUS) for Essential Tremor. All comments were reviewed
and incorporated into the final LCD where applicable.
Response to Comments: Percutaneous Vertebral Augmentation (PVA) for Vertebral
Compression Fracture (VCF)

First Coast Service Options, Inc. (First Coast) received a comment from an
interested party of the Medicare Administrative Contractor (MAC) Jurisdiction
N (JN) for Florida, Puerto Rico and the United States Virgin Islands, for the
Proposed Local Coverage Determination (LCD) DL34976 Percutaneous Vertebral
Augmentation (PVA) for Vertebral Compression Fracture (VCF). The advice of the
CAC members and Subject Matter Experts was considered in the development of
the proposed policy. All comments were reviewed and incorporated into the
final LCD where applicable.
Billing and Coding: Computed Tomography Cerebral Perfusion Analysis (CTP)

This article contains coding and other guidelines that complement the Local
Coverage Determination (LCD) for Computed Tomography Cerebral Perfusion
Analysis (CTP).

**Coding Information:**

Procedure codes may be subject to National Correct Coding Initiative (NCCI)
edits or 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.

A claim submitted without a valid ICD-10-CM diagnosis code will be returned to
the provider as an incomplete claim under Section 1833(e) of the Social
Security Act.

The diagnosis code(s) must best describe the patient's condition for which the
service was performed. For diagnostic tests, report the result of the test if
known; otherwise the symptoms prompting the performance of the test should be
reported.  
  

**Documentation Requirements:**

The patient's medical record should include but is not limited to:  
 The assessment of the patient by the ordering provider as it relates to the
complaint of the patient for that visit,  
 Relevant medical history  
 Results of pertinent tests/procedures  
 Signed and dated office visit record/operative report (Please note that all
services ordered or rendered to Medicare beneficiaries must be signed.)  
 Performance of the study in a stoke center

The patient's medical record must contain documentation that fully supports
the medical necessity for services included within the attached LCD. (See
"Indications and Limitations of Coverage" of the LCD.) This documentation
includes, but is not limited to, relevant medical history, physical
examination, and results of pertinent diagnostic tests or procedures.

Each claim must be submitted with ICD-10-CM codes that reflect the condition
of the patient and indicate the reason(s) for which the service was performed.
Claims submitted without ICD-10-CM codes will be denied.

The documentation of the study requires a formal written report, with clear
identifying demographics, the name of the interpreting provider, the reason
for the tests, an interpretive report and copies of images. The computerized
image reconstruction data should also be maintained.
Billing and Coding: Computed Tomography Cerebral Perfusion Analysis (CTP)

This article contains coding and other guidelines that complement the Local
Coverage Determination (LCD) for Computed Tomography Cerebral Perfusion
Analysis (CTP).

**Coding Information:**

Procedure codes may be subject to National Correct Coding Initiative (NCCI)
edits or 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.

A claim submitted without a valid ICD-10-CM diagnosis code will be returned to
the provider as an incomplete claim under Section 1833(e) of the Social
Security Act.

The diagnosis code(s) must best describe the patient's condition for which the
service was performed. For diagnostic tests, report the result of the test if
known; otherwise the symptoms prompting the performance of the test should be
reported.  
  

**Documentation Requirements:**

The patient's medical record should include but is not limited to:  
 The assessment of the patient by the ordering provider as it relates to the
complaint of the patient for that visit,  
 Relevant medical history  
 Results of pertinent tests/procedures  
 Signed and dated office visit record/operative report (Please note that all
services ordered or rendered to Medicare beneficiaries must be signed.)  
 Performance of the study in a stoke center

The patient's medical record must contain documentation that fully supports
the medical necessity for services included within the attached LCD. (See
"Indications and Limitations of Coverage" of the LCD.) This documentation
includes, but is not limited to, relevant medical history, physical
examination, and results of pertinent diagnostic tests or procedures.

Each claim must be submitted with ICD-10-CM codes that reflect the condition
of the patient and indicate the reason(s) for which the service was performed.
Claims submitted without ICD-10-CM codes will be denied.  

The documentation of the study requires a formal written report, with clear
identifying demographics, the name of the interpreting provider, the reason
for the tests, an interpretive report and copies of images. The computerized
image reconstruction data should also be maintained.
Billing and Coding: Transurethral Waterjet Ablation of the Prostate

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L38705 Transurethral Waterjet Ablation of the
Prostate. Please refer to the LCD for reasonable and necessary requirements.

**Coding Guidance**

**Notice:** It is not appropriate to bill Medicare for services that are not
covered (as described by the entire LCD) as if they are covered. When billing
for non-covered services, use the appropriate modifier.

**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.
Billing and Coding: Transurethral Waterjet Ablation of the Prostate

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L38707 Transurethral Waterjet Ablation of the
Prostate. Please refer to the LCD for reasonable and necessary requirements.

**Coding Guidance**

**Notice:** It is not appropriate to bill Medicare for services that are not
covered (as described by the entire LCD) as if they are covered. When billing
for non-covered services, use the appropriate modifier.

**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: Urological Supplies (DL33803)

During the 45-day comment period the DME MACs received a total of seven
comments: five comments were received from treating practitioners, one comment
from a supplier, and one comment from a supplier association.

Introduction to Responses

The DME MACs appreciate the comments received from stakeholders during the
open comment period on this proposed Urological Supplies Local Coverage
Determination (LCD).

Pursuant to the CMS Program Integrity Manual (CMS Pub. 100-08) Chapter 13, the
final policy and our response to comments are based on general acceptance by
the medical community, as evidenced by published original research in peer-
reviewed medical journals, systematic reviews and meta-analyses, evidence-
based consensus statements and clinical guidelines.
Billing and Coding: Screening for Cervical Cancer with Human Papillomavirus
(HPV)

It has come to our attention that services submitted for screening for
cervical cancer with Human Papillomavirus (HPV) Testing have been reported
incorrectly. This Billing and Coding Article provides billing and coding
guidance for these services.

**Coding Guidance**

**Notice:** It is not appropriate to bill Medicare for services that are not
covered as if they are covered. When billing for non-covered services, use the
appropriate modifier.

Consistent with National Coverage Determination (NCD) 210.2.1 screening HPV
services are to be billed with Healthcare Common Procedure Coding System
(HCPCS) code G0476. These services require dual diagnosis codes. The primary
International Statistical Classification of Diseases and Related Health
Problems, 10th revision, (ICD-10) code Z11.51 must be reported along with one
of the following secondary ICD-10-CM diagnosis codes: Z01.411 or Z01.419.

It is incorrect to report these screening services with Current Procedural
Terminology (CPT) code 87624 [Infectious agent detection by nucleic acid (DNA
or RNA); Human Papillomavirus (HPV), high-risk types].

Please refer to NCD 210.2.1 for complete information on screening for cervical
cancer with Human Papillomavirus (HPV).
Response to Comments: MolDX: Pharmacogenomics Testing

The comment period for the MolDX: Pharmacogenomics Testing DL38335 Local
Coverage Determination (LCD) began on 10/22/2019 and ended on 12/06/2019. The
comments below were received from the provider community. The notice period
for MolDX: Pharmacogenomics Testing L38335 begins on 07/02/2020  and will
become effective on 08/17/2020
Response to Comments: MolDX: Pharmacogenomics Testing

The comment period for the MolDX: Pharmacogenomics Testing DL38337 Local
Coverage Determination (LCD) began on 10/22/2019 and ended on 12/06/2019. The
comments below were received from the provider community. The notice period
for MolDX: Pharmacogenomics Testing L38337 begins on 07/02/2020 and will
become effective on 08/17/2020.
Billing and Coding: Transurethral Waterjet Ablation of the Prostate

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L38712, Transurethral Waterjet Ablation of the
Prostate. Please refer to the LCD for reasonable and necessary requirements.  
  
**Coding Guidance**  
  
**Notice:** It is not appropriate to bill Medicare for services that are not
covered (as described by the entire LCD) as if they are covered. When billing
for non-covered services, use the appropriate modifier.  
  
**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: Oxygen and Oxygen Equipment - DL33797

During the 45-day comment period, which ended on 02/10/2020, the DME MACs
received a total of sixty-five comments. Similar comments were grouped
together, resulting in twenty-three unique comments and responses.

_Introduction to Responses_

The DME MACs appreciate the comments received from stakeholders during the
open comment period on the proposed Oxygen and Oxygen Equipment Local Coverage
Determination (DL33797).

Pursuant to the CMS Program Integrity Manual (CMS Pub. 100-08) Chapter 13,
13.2.3 and 13.5.3:

_Acceptance by individual health care providers, or even a limited group of
health care providers, does not indicate general acceptance of the item or
service by the medical community._

_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 with chronic wounds.
Billing and Coding: Transurethral Waterjet Ablation of the Prostate

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L38726 Transurethral Waterjet Ablation of the
Prostate. Please refer to the LCD for reasonable and necessary requirements.

**Coding Guidance**

**Notice:** It is not appropriate to bill Medicare for services that are not
covered (as described by the entire LCD) as if they are covered. When billing
for non-covered services, use the appropriate modifier.

**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: Vitamin D Assay Testing

The following are the comment summaries and contractor responses for the
Proposed Local Coverage Determination (LCD) DL33996 (Vitamin D Assay Testing)
which was posted for comment on 01/23/2020, and presented at Open Meeting
2/18/2020. All comments were reviewed and incorporated into the final LCD
where applicable. The policy will be in notice July 23, 2020 thru September 6,
2020 and become active on September 7, 2020.
Response to Comments: MolDX: Predictive Classifiers for Early Stage Non-Small
Cell Lung Cancer

The comment period for the MolDX: Predictive Classifiers for Early Stage Non-
Small Cell Lung Cancer DL38327 Local Coverage Determination (LCD) began on
10/22/2019 and ended on 12/06/2019. No comments were received from the
provider community. The notice period for L38327 begins on 07/09/2020 and will
become effective on 08/24/2020.

The title for this LCD changed from "MolDX: Razor 14-Gene Lung Cancer Assay"
to "MolDX: Predictive Classifiers for Early Stage Non-Small Cell Lung Cancer".
Response to Comments: MolDX: Predictive Classifiers for Early Stage Non-Small
Cell Lung Cancer

The comment period for the MolDX: Predictive Classifiers for Early Stage Non-
Small Cell Lung Cancer DL38329 Local Coverage Determination (LCD) began on
10/22/2019 and ended on 12/06/2019. No comments were received from the
provider community. The notice period for L38329 begins on 07/09/2020 and will
become effective on 08/24/2020.

The title for this LCD changed from "MolDX: Razor 14-Gene Lung Cancer Assay"
to "MolDX: Predictive Classifiers for Early Stage Non-Small Cell Lung Cancer".
Billing and Coding: Percutaneous Vertebral Augmentation (PVA) for Vertebral
Compression Fracture (VCF)

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for Percutaneous
Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF) L38737.

**Coding Guidelines**  
Procedure codes may be subject to National Correct Coding Initiative (NCCI)
edits or 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: Implantable Continuous Glucose Monitors (I-CGM)

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for Implantable
Continuous Glucose Monitors (I-CGM) L38743.

**Coding Guidance**

**Implantation** of an implantable continuous glucose monitor (I-CGM) that
meets the appropriate criteria as mentioned in LCD L38743 Implantable
Continuous Glucose Monitors (I-CGM) is reported for either the 90 day or 180
day implantable sensor.

**For 90 day implantable glucose sensor report:**

 **CPT  code 0446T**\- Creation of subcutaneous pocket with insertion of
implantable interstitial glucose sensor, including system activation and
patient training

**Removal** of an I-CGM is reported with:

 **CPT  code 0447T**\- Removal of implantable interstitial glucose sensor
from subcutaneous pocket via incision

**Removal with immediate subsequent replacement** of an I-CGM is reported
with:

 **CPT  code 0448T**\- Removal of implantable interstitial glucose sensor
with creation of subcutaneous pocket at different anatomic site and insertion
of new implantable sensor, including system activation

**Notice:** It is not appropriate to bill Medicare for services that are not
covered (as described by the entire LCD) as if they are covered. When billing
for non-covered services, use the appropriate modifier.

**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.
Billing and Coding: Platelet Rich Plasma

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for Platelet Rich
Plasma L38745.
Billing and Coding: Peroral Endoscopic Myotomy (POEM)

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for Peroral Endoscopic
Myotomy (POEM) L38747.