Persius/hicric huggingface dataset:
Billing and Coding: Hypoglossal Nerve Stimulation for the Treatment of
Obstructive Sleep Apnea

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L38385, Hypoglossal Nerve Stimulation for the
Treatment of Obstructive Sleep Apnea. 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.  
  
 **Implantation** of a Hypoglossal Nerve Stimulator (HNS) for treatment of
Obstructive Sleep Apnea (OSA) is reported with:  
  
 **CPT code 64582 -** Open implantation of both the neurostimulator and its
corresponding electrode array.  
  
 **Revision or Replacement** of HNS for treatment of OSA is reported with:  
  
 **CPT code 64583** \- Revision or replacement of chest wall respiratory
sensor electrode or electrode array, including connection to existing pulse
generator.

**Replacement** of HNS for treatment of OSA is reported with:  
  
Per AMA CPT, use **CPT code 61886** for the Insertion or replacement of
cranial neurostimulator pulse generator or receiver, direct or inductive
coupling; with connection to two or more electrode arrays.  
  
 **Removal** of HNS for treatment of OSA is reported with:  
  
 **CPT code 64584** \- Removal of chest wall respiratory sensor electrode or
electrode array.  
  
 **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: MolDX: Prometheus IBD sgi Diagnostic Policy

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Prometheus
IBD sgi Diagnostic Policy L37260.

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 UB04 claim form
Billing and Coding: MolDX: MGMT Promoter Methylation Analysis

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: MGMT
Promoter Methylation Analysis L35974.

To report a MGMT Promoter Methylation Analysis service, please submit the
following claim information:

  * Select Bill Type Code 022x - Skilled Nursing - Inpatient (Medicare Part B only)
  * Select CPT code 81287
  * 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: 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 L36129.
Billing and Coding: Lab: Cystatin C Measurement

The information in this article contains billing, coding, or other guidelines
that complement the Local Coverage Determination (LCD) for Lab: Cystatin C
Measurement L37581.

**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. The medical record documentation must support the medical necessity of the services as directed in the related LCD.
  5. The laboratory or billing provider must have on file the physician requisition which sets forth the diagnosis or condition (ICD-10-CM code) that warrants the test(s).
  6. Examples of documentation requirements of the ordering physician/non-physician practitioner (NPP) include, but are not limited to, history and physical or exam findings that support the decision making, problems/diagnoses, relevant data (e.g., lab testing).
  7. Medical record documentation must support cystatin C test was performed on an adult patient with creatinine based eGFR 45-59 ml/min/1.73 m2 who does not have markers of kidney damage.
  8. Medical record documentation must clearly indicate the rationale which supports the medical necessity for performing eGFR by measurement of cystatin C (i.e., support GFR estimates based on serum creatinine are thought to be inaccurate and what decisions depend on more accurate knowledge of the GFR) and must reflect how the test results were used in the patient's plan of care.

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

  * Select CPT code 82610
  * Enter 1 unit of service (UOS)
  * Select the appropriate ICD-10-CM code

Note: The contractor has identified the Bill Type and Revenue Codes applicable
for use with the CPT/HCPCS codes included in this article. Providers are
reminded that not all CPT/HCPCS codes listed can be billed with all Bill Type
and/or Revenue Codes listed. CPT/HCPCS codes are required to be billed with
specific Bill Type and Revenue Codes. Providers are encouraged to refer to the
CMS Internet-Only Manual (IOM) Pub. 100-04, Claims Processing Manual, for
further guidance.
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 L36125.

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: Cardiology Non-emergent Outpatient Stress Testing

  
This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L38396 Cardiology Non-Emergent Outpatient Stress
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.  
  
Current Procedural Terminology (CPT) code 78434 should be reported in
conjunction with CPT code 78431 or 78492.  
  
Evaluation of the individual's left ventricular wall motion and ejection
fractions are routinely performed during SPECT MPI and are included in the
code's definition.  
  
Attenuation correction, when performed, is included in the MPI service.  
  
 **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. If the provider of the service is other than the ordering/referring physician, the provider of the service must maintain hard copy documentation of test results and interpretation, along with copies of the ordering/referring physician's order for the studies.
  5. The ordering physician must state the clinical indication/medical necessity for the study in the order for the test.
  6. Documentation must be maintained by the referring physician in the beneficiary's medical record that the required conditions (as indicated in the "Coverage Indications, Limitations and/or Medical Necessity" section of the LCD) for the stress test performed have been met.
  7. The rationale for selecting pharmacologic stress testing rather than exercise stress testing must be documented in the medical record.
  8. In the instance where regional wall motion abnormalities and ejection fraction have been assessed during the same episode of care by other testing modalities (e.g., echocardiography), the medical necessity of repeating this assessment through the use of nuclear imaging modalities must be clearly documented in the medical record.
  9. All segments of the service must have a formal interpretation and report.
Billing and Coding: Hypoglossal Nerve Stimulation for the Treatment of
Obstructive Sleep Apnea

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L38398, Hypoglossal Nerve Stimulation for the
Treatment of Obstructive Sleep Apnea. 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.  
  
 **Implantation** of a Hypoglossal Nerve Stimulator (HNS) for treatment of
Obstructive Sleep Apnea (OSA) is reported with:  
  
 **CPT code 64582 -** Open implantation of both the neurostimulator and its
corresponding electrode array.  
  
 **Revision or Replacement** of HNS for treatment of OSA is reported with:  
  
 **CPT code 64583** \- Revision or replacement of chest wall respiratory
sensor electrode or electrode array, including connection to existing pulse
generator.

**Replacement** of HNS for treatment of OSA is reported with:  
  
Per AMA CPT, use **CPT code 61886** for the Insertion or replacement of
cranial neurostimulator pulse generator or receiver, direct or inductive
coupling; with connection to two or more electrode arrays.  
  
 **Removal** of HNS for treatment of OSA is reported with:  
  
 **CPT code 64584** \- Removal of chest wall respiratory sensor electrode or
electrode array.  
  
 **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: ProMark Risk Score

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for ProMark Risk Score
L36665.

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
    * 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 ICD-10-CM code C61
Billing and Coding: MolDX: Genetic Testing for BCR-ABL Negative
Myeloproliferative Disease

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Genetic
Testing for BCR-ABL Negative Myeloproliferative Disease L36044. For single
genes performed by NGS, these tests must demonstrate compliance with L38047
MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies
and Suspected Myeloid Malignancies and its accompanying billing and coding
article, A54795 Billing and Coding: MolDX: Targeted and Comprehensive Genomic
Profile Next-Generation Sequencing Testing in Cancer.

To report Genetic Testing for BCR-ABL Negative Myeloproliferative Disease
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
    * 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: Melanoma Risk Stratification Molecular Testing

The information in this article contains billing, coding, or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Melanoma
Risk Stratification Molecular Testing L37725.

To report a molecular diagnostic 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: NRAS Genetic Testing

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: NRAS Genetic
Testing L35073.

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
    * 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 L37264.

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
Response to Comments: Corneal Hysteresis

The comment period for the Corneal Hysteresis L38026 Local Coverage
Determination (LCD) began on 5/6/19 and ended on 6/20/19. The comments below
were received from the provider community. The notice period for L38026 begins
on 9/5/19 and will become effective on 10/21/19.
Billing and Coding: MolDX: Percepta Bronchial Genomic Classifier

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Percepta
Bronchial Genomic Classifier L36908.

To report a Percepta Bronchial Genomic Classifier 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 837
    * 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 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) L36021.

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-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
Billing and Coding: MolDX: Genetic Testing for Hypercoagulability /
Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR)

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Genetic
Testing for Hypoercoagulability / Thrombophilia (Factor V Leiden, Factor II
Prothrombin, and MTHFR) L35984.

To report a Genetic Testing for Hypercoagulability / Thrombophilia 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
    * 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
Billing and Coding: MolDX: DecisionDx-UM (Uveal Melanoma)

The information in this article contains billing, coding, or other guidelines
that complement the Local Coverage Determination (LCD) MolDX: DecisionDx-UM
(Uveal Melanoma) (L37130).

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: Inivata, InVisionFirst, Liquid Biopsy for
Patients with Lung Cancer

The information in this article contains billing, coding, or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: InivataTM,
InVisionFirst, Liquid Biopsy for Patients with Lung Cancer L37903.

To report an InvisionFirst- Lung service, please submit the following claim
information:

  * Select CPT code 0388U
  * 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: MGMT Promoter Methylation Analysis

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: MGMT
Promoter Methylation Analysis L36113.

  
To report a MGMT Promoter Methylation Analysis service, please submit the
following claim information:

  
   Select Bill Type Code 022x - Skilled Nursing - Inpatient (Medicare Part B
only)

    Select CPT code 81287

    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