Persius/hicric huggingface dataset:
Billing and Coding: Visual Fields

The billing and coding information in this article is dependent on the
coverage indications, limitations and/or medical necessity described in the
associated LCD L34615 Visual Fields.

Taped and un-taped visual field testing is considered one unit of service for
MUE (medically unlikely edits) purposes. MUEs are established by a separate
CMS contractor, not WPS GHA.

If the claim contains a separate charge for gross visual fields, it will be
denied as an incidental service.

If the service is performed in a hospital inpatient or outpatient setting, the
modifier -26 should be used to indicate the professional component.

The HCPCS/CPT code(s) may be subject to Correct Coding Initiative (CCI) edits.
This policy does not take precedence over CCI edits. Please refer to the CCI
for correct coding guidelines and specific applicable code combinations prior
to billing Medicare.

Claims submitted for visual field examinations performed at unusually frequent
intervals may be reviewed in order to verify that the services were medically
reasonable and necessary.

_**For claims submitted to the Contractor or Part B MAC:**_

Claims for Visual Fields Testing services are payable under Medicare Part B in
the following places of service:

The global services (technical plus professional) may be billed in the
following places of service:

  * Office (11), nursing facility (32) and independent clinic (49).

The technical component may be billed in the following places of service:

  * Office (11), nursing facility (32), independent clinic (49), federally qualified health center (50) and rural health clinic (72).

The professional component may be billed at the following places of service:

  * Office (11), off-campus outpatient hospital (19), inpatient hospital (21), on-campus outpatient hospital (22), emergency room (23), skilled nursing facility (31), nursing facility (32), independent clinic (49) and comprehensive outpatient rehabilitation facility (62).
Billing and Coding: Vitamin D Assay Testing

The billing and coding information in this article is dependent on the
coverage indications, limitations and/or medical necessity described in the
associated LCD Vitamin D Assay Testing.

**A. General Guidelines for claims submitted to MAC A/B contractors:**

  1. 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.
  2. For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
  3. A claim submitted without a valid 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.

  4. For outpatient settings other than CORFs, references to "physicians" throughout this policy include non-physicians, such as nurse practitioners, clinical nurse specialists and physician assistants. Such non-physician practitioners, with certain exceptions, may certify, order, and establish the plan of care for Vitamin D Assay Testing services as authorized by State law.

**B. Billing Guidelines:**  
Bill type codes only apply to providers billing these services to Part A. Bill
type codes do not apply to physicians, other professionals, and suppliers who
bill these services to Part B. (See CMS Publication 100-04, _Medicare Claims
Processing Manual,_ Chapter 25 - Completing and Processing the Form CMS-1450
Data Set, Section 75.5 - From Locators 43-81, FL-67 Principal Diagnosis Codes,
for additional instructions.)

  1. All services/procedures performed on the same day for the same beneficiary by the physician/provider should be billed on the same claim.
  2. Claims for Vitamin D Assay Testing services are payable under Medicare Part B in the following places of service: office (11), independent clinic (49), Federally Qualified health Center (50) and independent lab (81).
Billing and Coding: MolDX: NRAS Genetic Testing

The following coding and billing guidance is to be used with its associated
Local coverage determination.

To report a NRAS Genetic Testing service, 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
    * 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
  * Select the appropriate ICD-10-CM code
Billing and Coding: MolDX: NRAS Genetic Testing

The following coding and billing guidance is to be used with its associated
Local coverage determination.

To report a NRAS Genetic Testing service, 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
    * 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
  * Select the appropriate ICD-10-CM code
Billing and Coding: Polysomnography and Sleep Testing

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L33405, Polysomnography and Sleep Testing. Please
refer to the LCD for reasonable and necessary requirements.

**Coding Guidance**

Non-attended sleep studies should be billed with the CPT/HCPCS code that most
accurately describes the service.

CPT code 95811 alone should be billed for split night studies as CPT code
95811 in this instance is inclusive of CPT code 95810. (Polysomnography; age 6
years or older, sleep staging with 4 or more additional parameters of sleep,
attended by a technologist)

For a study to be reported as polysomnography (PSG), sleep must be recorded
and staged and directly attended by a qualified technologist. Report with
modifier 52 if less than 6 hours of recording or in other cases of reduced
services.

CPT codes 95782, 95783, 95808, 95810, and 95811 include sleep staging.
Medicare would not expect to see separate billings for an EEG, EOG, and/or EMG
in addition to these codes.

CPT code 95808 includes reimbursement for one to three additional parameters.
CPT codes 95782, 95783, 95810 and 95811 include four or more additional
parameters. Therefore, Medicare would not expect to see separate billings for
additional parameters in addition to codes 95782, 95783, 95808, 95810, or
95811. Additional parameters of sleep include:

    * ECG
    * Airflow
    * Ventilation and respiratory effort
    * Gas exchange by oximetry, transcutaneous monitoring or end tidal gas analysis
    * Extremity muscle activity and motor activity movement
    * Extended EEG monitoring
    * Penile tumescence
    * Gastroesophageal reflux
    * Continuous blood pressure monitoring
    * Snoring
    * Body positions

**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.
  4. An order from the treating physician/nonphysician practitioner as required by CFR, Title 42, Volume 2, Chapter IV, Part 410.21 (a) Ordering diagnostic tests.
  5. When billing for a sleep disorder test, the ordering physician's NPI must be indicated on the claim form and the order kept on record.
  6. Documentation must support that the accreditation, credentialing, and training requirements as stated in the LCD were met for the clinic, technologist, and physician.
Billing and Coding: Chest X-Ray Policy

The following coding and billing guidance is to be used with its associated
Local coverage determination.
Billing and Coding: MolDX: Percepta Bronchial Genomic Classifier

The following coding and billing guidance is to be used with its associated
Local coverage determination.

To report a Percepta Bronchial Genomic Classifier service, please submit the
following claim information:

  * 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 837
    * 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
  * Select the appropriate ICD-10-CM code.
Billing and Coding: Magnetic-Resonance-Guided Focused Ultrasound Surgery
(MRgFUS) for Essential Tremor and Tremor Dominant Parkinson's Disease

The following coding and billing guidance is to be used with its associated
Local coverage determination.
Billing and Coding: ProMark Risk Score

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

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

  * Select CPT code 81479
  * 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
    * 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
  * Select ICD-10 CM code C61
Billing and Coding: MolDX: Prometheus IBD sgi Diagnostic Policy

The following coding and billing guidance is to be used with its associated
Local coverage determination.

To receive a Prometheus IBD sgi Diagnostic denial, please submit the following
claim information:

  * Select the applicable CPT code
  * Enter 1 unit of service (UOS)
  * An Advance Beneficiary Notice (ABN) is not required for statutorily excluded services 
    * For a voluntary issued ABN, append with GX modifier
    * To indicate a statutorily excluded service, append with a GY modifier
  * If submitting a DEX Z-CodeTM identifier, 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
  * If submitting a DEX Z-CodeTM identifier, 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 UB 04
Billing and Coding: MolDX: Immunohistochemistry (IHC) Indications for Breast
Pathology

Based on recommendations from the College of American Pathologists, the
American Society of Clinical Oncologists (ASCO), and the National
Comprehensive Cancer Network (NCCN), hormone receptor assays, estrogen
receptor (ER), progesterone receptor (PR), and Her-2/neu are the only current
biomarkers that demonstrate standardized value in breast cancer pathology
evaluation. Although other biomarkers, such as Ki-67, PI3K, and gene
expression assays, have been studied, no proven standardized value has been
established. Therefore, MolDX will allow ER, PR, and Her2 testing by IHC for
patients with primary invasive breast cancers and recurrent or metastatic
cancers.  
  
To report an IHC service for an ER, PR, Her2, submit the following claim
information:  
  

CPT Code | Specimen | UOS  
---|---|---  
88342 | First single/multiplex stain | 1  
88341 | Each additional | 2  
  
  
To report morphometric analysis, **select one** of the following codes based
on the type of morphometric analysis:  
  

CPT Code | Service Type | UOS  
---|---|---  
88360 | Manual | 3  
88361 | Computer-assisted | 3  
  
  
Note: a unit of service applies to a single separately identifiable specimen.
Billing and Coding: MolDX: Molecular Diagnostic Tests (MDT)

The information in this article contains billing, coding, or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Molecular
Diagnostic Tests (MDT) L35160.

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

  * Select appropriate CPT code
  * 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
    * Item 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

**NOTE:** When entering the DEX Z- Code on the SV101-7 documentation field
for Part B claims please do not add additional characters and/or information
on the line.
Billing and Coding: MolDX: Molecular Diagnostic Tests (MDT)

The information in this article contains billing, coding, or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Molecular
Diagnostic Tests (MDT) L36256.

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

  * Select appropriate CPT code
  * 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
    * Item 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

**NOTE:** When entering the DEX Z- Code on the SV101-7 documentation field
for Part B claims please do not add additional characters and/or information
on the line.
Billing and Coding: Allergy Testing

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L33261 Allergy Testing. 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.  
  
Consistent with the related LCD, CPT code 82785 Gammaglobulin
[immunoglobulin]; IgE is not appropriate in most general allergy testing.
Please refer to the LCD for details on medically reasonable and necessary
guidelines.  
  
It is not usually necessary to report CPT code 86003 Allergen specific IgE;
quantitative or semiquantitative, crude allergen extract (in vitro testing) in
addition to skin testing. Please see the related LCD for medically reasonable
and necessary guidelines.  
  
 **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 medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.
  4. Prior to performance of allergy testing, there must be evidence in the medical record that a history has been obtained, indicating the possible presence of allergy.
    * This history should support that attempts to narrow the area of investigation were taken so that the minimal number of necessary skin tests might deliver a diagnosis.
    * The history should support that the selection of antigens was based on the patient specific history and physician examination.
  5. The medical record must indicate which allergy test(s) were used, the interpretation(s), and measurement (in mm) of reaction size of both wheal and erythema response or a standardized grading system in vivo testing (as applicable).
Billing and Coding: Autonomic Function Testing

The billing and coding information in this article is dependent on the
coverage indications, limitations and/or medical necessity described in the
related LCD.

**Documentation Requirements**

  1. Medical record documentation maintained by the performing provider must clearly support the medical necessity for ANS testing as well as the test reports and interpretation. Supportive documentation showing medically reasonable and necessary indications as outlined in this LCD are expected to be documented in the medical record and be available upon request. This documentation includes, but is not limited to, relevant medical history, physical examination and results of pertinent diagnostic tests or procedures used to rule out more common causes of autonomic signs or symptoms.
  2. General professional standards with FDA clearance apply for all equipment used in ANS testing.

**Utilization Guidelines**

  1. Diagnostic testing may be allowed once to confirm or exclude specific autonomic disease. For patients with diagnosed autonomic disorders, repeat testing is governed by a change in clinical status or response to a therapeutic intervention. If a repeat test is needed, it is not expected to exceed once per year. 
  2. Providers who perform these tests on an unusually high proportion of their patients, or at frequencies exceeding once per year may be subject to medical review.
  3. Providers who do not have tilt tables and are using the code range 95921-95924 may be subject to medical review.
Billing and Coding: Coronary Computed Tomography Angiography (CCTA)

The billing and coding information in this article is dependent on the
coverage indications, limitations and/or medical necessity described in the
associated LCD Coronary Computed Tomography Angiography (CCTA).
Billing and Coding: Immune Globulins

The billing and coding information in this article is dependent on the
coverage indications, limitations and/or medical necessity described in the
related LCD.

**Documentation Requirements**  
Medical records must include the indications to support using IVIG. For those
indications stating routine use is not indicated, the medical record must
document the interventions that were unsuccessful or the reason they were not
tolerated.

Documentation must support objective response for continued coverage. Medical
Records must be made available to the Contractor upon request.
Billing and Coding: BDX-XL2

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for BDX-XL2 L37216.
Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Biomarkers
in Cardiovascular Risk Assessment L36523.
Billing and Coding: MolDX: Breast Cancer Assay: Prosigna

The information in this article contains billing, coding, or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Breast
Cancer Assay: Prosigna L36811.

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

  * Select CPT code 81520
  * 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: Decision Dx-UM (Uveal Melanoma)

The billing and coding information in this article is dependent on the
coverage indications, limitations and/or medical necessity described in the
associated LCD L37210, MolDX: Decision Dx-UM (Uveal Melanoma).

To report a DecisionDx-UM (Uveal Melanoma) service, please submit the
following claim information:

 Select CPT code 81552  
 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: EndoPredict Breast Cancer Gene Expression Test

The information in this article contains billing, coding, or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: EndoPredict
Breast Cancer Gene Expression Test L37663.

To report an EndoPredict service, please submit the following claim
information:

  * Select CPT code 81522
  * 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: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis
Diagnostic Test

The information in this article contains billing, coding, or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: EnvisiaTM,
VeracyteTM, Idiopathic Pulmonary Fibrosis Diagnostic Test (L37919).

To report an EnvisiaTM Genomic Classifier service, please submit the following
claim information:

  * Select CPT code 81554
  * 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