Persius/hicric huggingface dataset:
**Abstract:**  
  
Corneal topography is a computer assisted diagnostic technique where a special
instrument projects a series of light rings on the cornea, creating a color
coded map of the corneal surface as well as a cross-section profile. This
service is used to provide a detailed map or chart of the physical features
and shape of the anterior surface of the cornea. This permits a more nearly
accurate portrayal of the physical state of the cornea and for the detection
of subtle corneal surface irregularity and astigmatism.  
  
  
  
 **  Indications:**  
  
Computerized corneal topography is considered medically necessary under any of
the following conditions:  
  

  * pre-operative evaluation of irregular astigmatism for intraocular lens power determination with cataract surgery;
  * monocular diplopia;
  * diagnosis of early keratoconus;
  * post-surgical or post-traumatic astigmatism, measuring at a minimum of 3.5 diopters;
  * suspected irregular astigmatism based on retinoscopic streak or conventional keratometry;
  * post-penetrating keratoplasty surgery;
  * post-surgical or post-traumatic irregular astigmatism;
  * certain corneal dystrophies;
  * complications of transplanted cornea;
  * post-traumatic corneal scarring; and/or
  * pterygium and/or corneal ectasia that cause visual impairment.

**Limitations:**  
  
Corneal topography will only be allowed for a pre-operative cataract patient
if documentation supports that the patient has irregular astigmatism. Its use
for this purpose should be rare.  
  
Corneal topography is to be billed only when the diagnosis of monocular
diplopia is thought to be caused by a corneal irregularity.  
  
Corneal topography is a covered service for the above indications when
medically reasonable and necessary only if the results will assist in defining
further treatment. It is not covered for routine follow-up testing.  
  
Repeat testing is only indicated if a change of vision is reported in
connection with one of the above listed conditions.  
  
Services performed for screening purposes or in the absence of associated
signs, symptoms, illness or injury as indicated above, will be denied as non-
covered.  
  
Corneal topography will be non-covered if performed pre- or post-operatively
in relation to a Medicare non-covered procedure, e.g., radial keratotomy.  
  
  
  
 **Other Comments:**  
  
For claims submitted to the Part A MAC: this coverage determination also
applies within states outside the primary geographic jurisdiction with
facilities that have nominated CGS Administrators, LLC. to process their
claims.  
  
  
Limitation of liability and refund requirements apply when denials are likely,
whether based on medical necessity or other coverage reasons. The
provider/supplier must notify the beneficiary in writing, prior to rendering
the service, if the provider/supplier is aware that the test, item or
procedure may not be covered by Medicare. The limitation of liability and
refund requirements do not apply when the test, item or procedure is
statutorily excluded, has no Medicare benefit category or is rendered for
screening purposes.
**History/Background and/or General Information**

Ionized calcium is a cation that circulates freely in the bloodstream and
comprises 46-50% of all circulating calcium. Only the ionized calcium can be
used by the body in such vital processes as muscular contraction, cardiac
function, transmission of nerve impulses, and blood clotting. Ionized calcium
is considered a more sensitive and accurate indicator for many operative
procedures and disease processes. A normal serum ionized calcium for an adult
is 4.65 - 5.28 mg/dl.

**Covered Indications**

An Ionized Calcium test will be considered medically necessary under any of
the following circumstances:

  * Evaluation of patients with clinical signs and symptoms of hyperparathyroidism such as weakness, fatigue, bone pain, confusion, depression, nausea, vomiting, polyuria, etc. in which parathyroid disease is suspected;
  * Evaluation of patients with clinical signs and symptoms of hypoparathyroidism such as Chvostek's sign, Trousseau's sign, dysphagia, tetany, increased deep tendon reflexes, etc. in which parathyroid disease is suspected;
  * Evaluation of a patient with an abnormal total calcium level;
  * Monitoring of a patient with renal disease, renal transplantation, or hemodialysis;
  * Patients with previously diagnosed hyper or hypoparathyroidism;
  * Patients with pancreatitis as characterized by symptoms such as epigastric abdominal pain, nausea and/or vomiting, fever, hypotension, mild jaundice, umbilical discoloration (Cullen's sign), etc.;
  * Patients with a magnesium deficiency and/or excessive Vitamin D;
  * Patients with sepsis as characterized by symptoms such as hypotension, tachycardia, tachypnea, change in mental status, etc.; and
  * Patients with ectopic parathyroid hormone producing neoplasms.

**Limitations**

As published in the CMS IOM Publication 100-08, _Medicare Program Integrity
Manual_ , Chapter 13, Section 13.5.4, an item or service may be covered by a
contractor LCD if it is reasonable and necessary under the Social Security Act
Section 1862 (a)(1)(A). Contractors shall determine and describe the
circumstances under which the item or service is considered reasonable and
necessary.
**History/Background and/or General Information**

The erythrocyte sedimentation rate (ESR) is a sensitive but nonspecific test
that is frequently the earliest indicator of disease when other chemical or
physical signs are normal. It is most often used as a gauge for determining
the progress and detection of an inflammatory disorder caused by infection,
autoimmune mechanisms, or connective tissue disease.

**Covered Indications**

An ESR will be considered medically reasonable and necessary for one of the
following conditions:

  * Aiding in the diagnosis of temporal arteritis (giant cell arteritis) and polymyalgia rheumatic
  * Monitoring disease activity in temporal arteritis and polymyalgia rheumatica for the principal indication of adjusting the dosage of corticosteroids
  * Monitoring patients with treated Hodgkin's disease
  * Monitoring patients with autoimmune diseases, inflammatory disorders caused by infection, or connective tissue diseases

An ESR should be used selectively in patients with symptoms that are not
explained by results of a careful history and physical examination. Rapid
screen for elevated protein or globulin level in serum ESR may be used with or
replaced by C-Reactive protein in evaluation of unexplained inflammatory
states .

**Limitations**

This service is not medically necessary for screening purposes.

As published in the CMS IOM Publication 100-08, Medicare Program Integrity
Manual, Chapter 13, Section 13.5.4, an item or service may be covered by a
contractor LCD if it is reasonable and necessary under the Social Security Act
Section 1862 (a)(1)(A). Contractors shall determine and describe the
circumstances under which the item or service is considered reasonable and
necessary.
**Covered Indications**

Ultrasound of the head and neck will be considered medically reasonable and
necessary when used for the following indications:

  * Evaluation of abnormalities in the tissues and/or organs of the head and neck (i.e., palpable masses)
  * Evaluation of abnormalities detected on other imaging examinations (i.e., areas of abnormal uptake seen on radioisotope thyroid examinations)
  * Personal or family history of thyroid malignancies
  * Evaluation of suspected regional nodal metastases in patients with a proven thyroid carcinoma
  * Follow-up of lesion/nodule (i.e., after medical suppression therapy)
  * Localization of thyroid/parathyroid glands or cervical lymph nodes for biopsy, ablation, or other interventional procedures

For guidance regarding ordering tests, provider qualifications and supervision
of diagnostic testing, please refer to 42 CFR 410.32 - Diagnostic x-ray
tests, diagnostic laboratory tests, and other diagnostic tests: Conditions.

**Limitations**

As published in the CMS IOM Publication 100-08, _Medicare Program Integrity
Manual_ , Chapter 13, Section 13.5.4, an item or service may be covered by a
contractor LCD if it is reasonable and necessary under the Social Security Act
Section 1862 (a)(1)(A). Contractors shall determine and describe the
circumstances under which the item or service is considered reasonable and
necessary.
**Abstract:**  
  
B-type natriuretic peptide (BNP) is a cardiac neurohormone produced mainly in
the left ventricle. It is secreted in response to ventricular volume expansion
and pressure overload, conditions often present in congestive heart failure
(CHF). Used in conjunction with other clinical information, measurement of BNP
levels (either total or N-terminal) is useful in rapidly establishing or
excluding the diagnosis or worsening of CHF in patients with acute
exacerbation of dyspnea. Also, BNP levels determined in the first few days
after an acute coronary syndrome or event (ACS) may be useful in the
prediction of longer-term cardiovascular risk but this risk assessment does
not change the management of ACS and is non-covered by regulation.  
  
 **Indications:**  
  
BNP measurements may be considered reasonable and necessary when used in
combination with other medical data such as medical history, physical
examination, laboratory studies, and chest x-ray.

    * to diagnose or to differentiate heart failure from other potential clinical conditions **if** the patient's signs and/or symptoms are consistent with both heart failure and one or more other conditions, e.g., acute dyspnea in a patient with known or suspected pulmonary disease.

    * to diagnose or differentiate worsening heart failure if use of the test replaces other diagnostic tests, such as chest film; and/or to confirm the diagnosis when other diagnostic tests are equivocal.

  
**  Limitations:**

    * BNP measurements must be assessed in conjunction with standard diagnostic tests, medical history and clinical findings. The efficacy of BNP measurement as a stand-alone test has not been established yet.

    * BNP measurements for monitoring and management of CHF are non-covered. Treatment guided by BNP has not been shown to be superior to symptom-guided treatment in either clinical or quality-of-life outcomes.

    * The efficacy but not the utility of BNP as a risk stratification tool (to assess risk of death, myocardial infarction or congestive heart failure) among patients with acute coronary syndrome (myocardial infarction with or without T-wave elevation and unstable angina) has been established. However, the assessment of BNP level has not been shown to alter patient management. The BNP is not sufficiently sensitive to either preclude or necessitate any other evaluation or treatment in this group of patients.

    * Screening examinations are statutorily non-covered.
**Indications**  
  
CT colonography, also known as virtual colonoscopy utilizes helical computed
tomography of the abdomen and pelvis along with 2D or 3D reconstruction to
visualize the colon lumen. The test requires colonic preparation similar to
that required for instrument (fiberoptic, video) colonoscopy, as well as air
insufflation to achieve colonic distention.  
  
Virtual colonoscopy is only indicated in those patients in whom a diagnostic
or surveillance instrument colonoscopy of the entire colon is incomplete due
to an inability to fully pass the colonoscope proximally, and a repeat attempt
is not indicated. Virtual colonoscopy is intended for use in pre-operative
planning only when imaging of the non-visualized colon proximal to the
obstruction is medically necessary in making decisions involving the approach
to the patient.  
  
Incomplete colonoscopy must be due to one of the following:  
  
1\. An obstructing neoplasm,  
  
2\. Intrinsic scarring, stricture, aberrant anatomy, or obstruction from prior
surgery, radiation, or diverticular disease.  
  
3\. Extrinsic compression.  
  
4\. Patient safety. There are few absolute contraindications to instrument
colonoscopy. Relative contraindications do not create medical necessity for
using virtual colonoscopy as a screening procedure, and the above indications
must still be met.  
  
The following relative contraindications to instrument colonoscopy may be
indications for virtual colonoscopy if well documented in the medical record
and the patient's primary physician and the colonoscopist agree on the
increased risk to the patient:  
  
  

    * Severe coagulopathy



    * Long-term anticoagulation



    * Increased sedation risk (such as from severe COPD or previous anesthesia adverse reaction)

  
  
  
  
**Limitations**  
Virtual colonoscopy is not covered when used for screening, or in the absence
of signs or symptoms of disease, regardless of family history or other risk
factors for the development of colonic disease.  
  
Virtual colonoscopy is not covered when used as an alternative to instrument
colonoscopy for screening or in the absence of signs or symptoms of disease.  
  
Virtual colonoscopy is not covered following incomplete colonoscopy if the
reason for the colonoscopy is other than one of those described above.
**Abstract:**  
  
Radioallergosorbent test (RAST), fluoroallergosorbent test (FAST), and
multiple antigen simultaneous tests are in vitro techniques for determining
whether a patient's serum contains IgE antibodies against specific allergens
of clinical importance. As with any allergy testing, the need for such tests
is based on the findings during a complete history and physical examination of
the patient.  
  
The multiple antigen simultaneous testing technique is similar to the
RAST/FAST techniques in that it depends upon the existence of allergic
antibodies in the blood of the patient being tested. With the multiple antigen
simultaneous test system, several antigens may be used to test for specific
IgE simultaneously.  
  
ELISA (enzyme-linked immunosorbent assay) is another in vitro method of
allergy testing for specific IgE antibodies against allergens. This method is
also a variation of RAST.  
  
 **Limitations:**  
  
The following tests are considered to be not medically necessary and will be
denied.

  * ELISA/Act qualitative antibody testing  
This testing is used to determine in vitro reaction to various foods and
relies on lymphocyte blastogenesis in response to certain food antigens.

  * LMRA (Lymphocyte Mitogen Response Assays) by ELISA/Act
  * IgG ELISA, indirect method 
  * Qualitative multi-allergen screen   
This is a non-specific test that does not identify a specific antigen.

  * IgG and IgG subclass antibody tests for food allergy do not have clinical relevance, are not validated, lack sufficient quality control, and should not be performed.
This policy addresses the injection of chemical substances, such as local
anesthetics, steroids, sclerosing agents and/or neurolytic agents into
ganglion cysts, tendon sheaths, tendon origins/insertions, ligaments or near
nerves of the feet (e.g., Morton's neuroma) to affect therapy for a
pathological condition.  
  
 **Note:** the term **"Morton's neuroma"** is used in this policy generically
to refer to a swollen inflamed nerve in the ball of the foot, including the
more specific conditions of Morton's neuroma (lesion within the third
intermetatarsal space), Heuter's neuroma (first intermetatarsal space),
Hauser's neuroma (second intermetatarsal space) and Iselin's neuroma (fourth
intermetatarsal space). This policy applies to each.  
  
Injection of a carpal tunnel or tarsal tunnel is indicated for the patient
with a mild case of these syndromes, with or without a trial of other
conservative measures, such as oral non-steroidal anti-inflammatory drugs
(NSAIDs) or orthoses.  
  
Injection into tendon sheaths, ligaments, tendon origins or insertions,
ganglion cysts, neuromas or other areas described by this policy may be
indicated to relieve pain or dysfunction resulting from inflammation or other
pathological changes. Proper use of this modality with local anesthetics
and/or steroids should be short-term, as part of an overall management plan
including diagnostic evaluation, in order to clearly identify and properly
treat the primary cause. In some circumstances after diagnosis has been
confirmed, injection of a sclerosing or neurolytic agent may be appropriate
for longer-term management.  
  
The signs or symptoms that justify these treatments should be resolved or
reevaluated after one to three injections (see reference 2 below, under
"Sources of Information and Basis for Decision"). **Injections beyond three to
the same tendon origin/insertion, tendon sheath, ganglion, neuroma, ligament
or local area in a six month period** must be justified by the clinical record
indicating a logical reason for failure of the prior therapy and why further
treatment can reasonably be expected to succeed. A recurrence may justify a
second course of therapy.  
  
Medical necessity for injections of more than two sites at one session or for
frequent or repeated injections is questionable. Such injections are likely to
result in a request for medical records which must evidence careful
justification of necessity.  
  
"Dry needling" of ganglion cysts, ligaments, neuromas, tendon sheaths and
their origins/insertions are non-covered procedures.  
  
Compliance with the provisions in this policy is subject to monitoring by post
payment data analysis and subsequent medical review.
**Abstract:**  
  
For the purpose of this LCD, Transcatheter Therapy is defined as the infusion
of medication (other than chemotherapy and thrombolysis) through an inserted
arterial (angiographic) catheter for the purpose of delivering specific
medication to a localized vascular bed. Therapeutic infusion of medications is
covered for indications identified in the LCD, when other routes of
administration are not appropriate or effective. The treatment is reimbursable
as a single service, regardless of the duration of the infusion.  
  
 **Indications:**  
  
Transcatheter infusion therapy is indicated for the prolonged **therapeutic**
administration (infusion) of a medication through a previously inserted
arterial angiographic catheter for the purpose of delivering the medication to
an individual vascular bed. Such administration assumes that the drug could
not be delivered effectively via any other route (e.g., sublingual,
intravenous, intramuscular, subcutaneous, etc) and **must** be infused via the
indwelling catheter to be effective.  
  
 **Infusion** is defined as the **prolonged, continuous** administration of
the medication through the catheter lasting a minimum of 30 minutes. It may
require the use of an infusion pump. Bolus, "push" or "slow push" injections
are not infusions.  
  
Transcatheter infusions may be indicated for the treatment of:

  * cerebrovasospasm
  * bleeding involving the head or neck
  * gastrointestinal hemorrhage
  * non-occlusive mesenteric ischemia.
  * Raynaud's syndrome
  * Medications for which infusion is a reimbursable service include: 
    * nitroglycerin (for cerebrovascular spasm, only)
    * neosynephrine
    * vasopressin
    * somatastatin
    * papaverine
    * reserpine

**Limitations:**  
  
Transcatheter administration of medications or other biologics for reasons
other than treatment (e.g., medications administered for diagnostic purposes;
contrast agents administered for imaging) and medications administered
incidental to a diagnostic procedure, albeit for therapeutic reasons (e.g.,
nitroglycerin administered intra-coronary during coronary angiography), are
not covered or reimbursable under this code.  
  
CPT codes for transcatheter infusion therapy is reimbursable only once per
encounter, regardless of the number of medications infused or duration of the
infusion beyond 30 minutes.  
  
Infusions for the treatment of primary pulmonary hypertension are considered
investigational and will be denied as not medically necessary.  
  
Infusions for medications normally given by bolus or "push" technique or by
another route will be denied as not medically necessary.
The electrocardiogram (ECG, EKG) and ECG rhythm strip records the electrical
activity of the heart throughout the cardiac cycle of contraction
(depolarization) and relaxation (repolarization). The changes in electrical
potential during the cardiac cycle are detected at the body surface and
recorded on graph paper. The recording is reviewed by a physician who provides
an interpretation and written report. An ECG may be reported as the technical
aspect only, the interpretation and written report only, or both aspects
together as one service.  
  
The electrical activity of the heart can be viewed along various electrical
axes (viewpoints). Each viewpoint is described as a "lead". A typical ECG
views the heart from 12 axes and, therefore, has 12 leads. A rhythm strip
typically includes one to three leads. Typically, a 12-lead ECG is a separate
document from the medical progress notes, while a printed rhythm strip may be
pasted into the progress notes.  
  
An ECG is indicated to diagnose or treat a patient for symptoms, signs, or a
history of heart disease; or systemic conditions that affect the heart,
including:

  * Chest pain or angina pectoris,
  * Myocardial ischemia or infarction,
  * Arteriovascular disease including coronary, central, and peripheral disease,
  * Hypertension,
  * Conduction abnormalities,
  * Cardiac rhythm disturbances,
  * Cardiac hypertrophy,
  * Heart failure,
  * Pericarditis,
  * Structural cardiac conditions,
  * Endocrine abnormalities,
  * Neurological disorders affecting the heart,
  * Syncope,
  * Paroxysmal weakness,
  * Palpitations,
  * Sudden lightheadedness,
  * Electrolyte imbalance,
  * Acid-base disorders,
  * Temperature disorders,
  * Pulmonary disorders, and
  * Drug cardiotoxicity.

  
An ECG may help identify cardiac disorders as part of a preoperative clinical
evaluation. A preoperative ECG may be reasonable and necessary under one of
the following conditions:

  * In the presence of pre-existing heart disease such as congestive heart failure, prior myocardial infarction (MI), angina, coronary artery disease, or dysrhythmias;
  * In the presence of known comorbid conditions that may affect the heart, such as chronic pulmonary disease, peripheral vascular disease, diabetes, or renal impairment; or
  * When the pending surgery requires a general or regional anesthetic.

NA

NA