Persius/hicric huggingface dataset:
**

A. Diagnostic Tests

**

Do not routinely pay for the following diagnostic tests because they are
obsolete and have been replaced by more advanced procedures. The listed tests
may be paid for only if the medical need for the procedure is satisfactorily
justified by the physician who performs it. When the services are subject to
the Quality Improvement Organization (QIO) Review, the QIO is responsible for
determining that satisfactory medical justification exists.

When the services are not subject to QIO review, the A/B Medicare
Administrative Contractor is responsible for determining that satisfactory
medical justification exists. This includes:

  * Amylase, blood isoenzymes, electrophoretic,
  * Chromium, blood,
  * Guanase, blood,
  * Zinc sulphate turbidity, blood,
  * Skin test, cat scratch fever,
  * Skin test, lymphopathia venereum,
  * Circulation time, one test,
  * Cephalin flocculation,
  * Congo red, blood,
  * Hormones, adrenocorticotropin quantitative animal tests,
  * Hormones, adrenocorticotropin quantitative bioassay,
  * Thymol turbidity, blood,
  * Skin test, actinomycosis,
  * Skin test, brucellosis,
  * Skin test, psittacosis,
  * Skin test, trichinosis,
  * Calcium, feces, 24-hour quantitative,
  * Starch, feces, screening,
  * Chymotrypsin, duodenal contents,
  * Gastric analysis, pepsin,
  * Gastric analysis, tubeless,
  * Calcium saturation clotting time,
  * Capillary fragility test (Rumpel-Leede),
  * Colloidal gold,
  * Bendien's test for cancer and tuberculosis,
  * Bolen's test for cancer,
  * Rehfuss test for gastric acidity, and
  * Serum seromucoid assay for cancer and other diseases.

**

B. Cardiovascular Tests

**

Do not pay for the following phonocardiography and vectorcardiography
diagnostic tests because they have been determined to be outmoded and of
little clinical value. They include:

  * Phonocardiogram with or without ECG lead; with supervision during recording with interpretation and report (when equipment is supplied by the physician),
  * Phonocardiogram; tracing only, without interpretation and report (e.g., when equipment is supplied by the hospital, clinic),
  * Phonocardiogram; interpretation and report,
  * Phonocardiogram with ECG lead, with indirect carotid artery and/or jugular vein tracing, and/or apex cardiogram; with interpretation and report,
  * Phonocardiogram; without interpretation and report,
  * Phonocardiogram; interpretation and report only,
  * Intracardiac,
  * Vectorcardiogram (VCG), with or without ECG; with interpretation and report,
  * Vectorcardiogram; tracing only, without interpretation and report, and,
  * Vectorcardiogram; interpretation and report only.
The sweat test is an important diagnostic tool in cystic fibrosis and may be
covered when used for that purpose. Usage of the sweat test as a predictor of
efficacy of sympathectomy in peripheral vascular disease is unproven and,
therefore, is not covered.
A hernia support (whether in the form of a corset or truss) which meets the
definition of a brace is covered under Part B under 1861(s)(9) of the Act.
Based on professional advice, it has been determined that the sykes hernia
control (a spring-type, U-shaped, strapless truss) is not functionally more
beneficial than a conventional truss. Make program reimbursement for this
device only when an ordinary truss would be covered. (Like all trusses, it is
only of benefit when dealing with a reducible hernia). Thus, when a charge for
this item is substantially in excess of that which would be reasonable for a
conventional truss used for the same condition, base reimbursement on the
reasonable charges for the conventional truss.
A prosthetic shoe (a device used when all or a substantial portion of the
front part of the foot is missing) can be covered as a terminal device; i.e.,
a structural supplement replacing a totally or substantially absent hand or
foot. The coverage of artificial arms and legs includes payment for terminal
devices such as hands or hooks even though the patient may not require an
artificial limb. The function of the prosthetic shoe is quite distinct from
that of excluded orthopedic shoe and supportive foot devices which are used by
individuals whose feet, although impaired, are essentially intact. (Section
1862(a)(8) of the Act excludes payment for orthopedic shoes or other
supportive devices for the feet.)
Medicare payment may be made for several visits by the home health nurse to
teach the patient or the caring person to give subcutaneous injections of low
dose heparin if it is prescribed by a physician for a homebound patient who:

  * Is pregnant and requires anticoagulant therapy, or
  * Requires treatment for deep venous thrombosis or pulmonary emboli or for another condition requiring anticoagulation and documentation justifies that the patient cannot tolerate warfarin.

If the patient or caring person is unable to administer the injection, nursing
visits to give the injections on a daily basis, 7 days a week, for a period of
up to 6 months (in the case of pregnancy, visits may be made for a period
beyond 6 months if reasonable and necessary) would be reimbursed by Medicare.
Coverage for these services after 6 months of treatment would be provided only
if the prescribing physician can justify and document the need for such an
extended course of treatment. Documentation of need for heparin injections
beyond 6 months would not be required for pregnant patients who meet the
homebound criteria.
**220.6 - Positron Emission Tomography (PET) Scans (RETIRED)  
(Rev. 11892; Issued: 03-09-23; Effective: 04-10-23; Implementation:
04-10-23)**

Effective January 1, 2022, the Centers for Medicare & Medicaid Services
removed the umbrella national coverage determination (NCD) for Positron
Emission Tomography (PET) Scans. In the absence of an NCD, coverage
determinations for all oncologic and non-oncologic uses of PET that are not
included in another NCD under section 220.6 will be made by the Medicare
Administrative Contractors under section 1862(a)(1)(A) of the Social Security
Act. All PET indications currently covered or non-covered under NCDs under
section 220.6 remain unchanged and MACs shall not alter coverage for
indications covered under NCDs.
It is important to note that the names of these tests are not standardized.
Following are some of the acceptable tests, recognizing that this list is not
inclusive and that local medical consultants should make determinations:

**

Direct Tests

**

  * Carotid Phonoangiography
  * Direct Bruit Analysis
  * Spectral Bruit Analysis
  * Doppler Flow Velocity
  * Ultrasound Imaging including Real Time
  * B-Scan and Doppler Devices

**

Indirect Tests

**

  * Periorbital Directional Doppler Ultrasonography
  * Oculoplethysmography
  * Ophthalmodynamometry
Endothelial cell photography is a covered procedure under Medicare when
reasonable and necessary for patients who meet one or more of the following
criteria:

  * Have slit lamp evidence of endothelial dystrophy (cornea guttata),
  * Have slit lamp evidence of corneal edema (unilateral or bilateral),
  * Are about to undergo a secondary intraocular lens implantation,
  * Have had previous intraocular surgery and require cataract surgery,
  * Are about to undergo a surgical procedure associated with a higher risk to corneal endothelium; i.e., phacoemulsification, or refractive surgery (see 80.7 for excluded refractive procedures),
  * With evidence of posterior polymorphous dystrophy of the cornea or irido-corneal-endothelium syndrome, or
  * Are about to be fitted with extended wear contact lenses after intraocular surgery.

When a pre-surgical examination for cataract surgery is performed and the
conditions of this section are met, if the only visual problem is cataracts,
endothelial cell photography is covered as part of the presurgical
comprehensive eye examination or combination brief/intermediate examination
provided prior to cataract surgery, and not in addition to it. (See
[10.1](https://www.cms.gov/medicare-coverage-database/details/ncd-
details.aspx?ncdid=60).)
Telephone transmission of EEGs is covered as a physician's service or as
incident to a physician's service when reasonable and necessary for the
individual patient, under appropriate circumstances. The service is safe, and
may save time and cost in sending EEGs from remote areas without special
competence in neurology, neurosurgery, and electroencephalography, by avoiding
the need to transport patients to large medical centers for standard EEG
testing.
**160.22  Ambulatory EEG Monitoring (RETIRED)  
_(Rev. 11892; Issued: 03-09-23; Effective: 04-10-23; Implementation:
04-10-23)**

_

_Effective January 1, 2023, NCD 160.22 is retired._
Stereotaxic depth electrode implantation prior to surgical treatment of focal
epilepsy for patients who are unresponsive to anticonvulsant medications has
been found both safe and effective for diagnosing resectable seizure foci that
may go undetected by conventional scalp EEGs.
**B. Nationally Covered Indications**

Effective for services performed on or after April 13, 2021, the Centers for
Medicare & Medicaid Services (CMS) will cover autologous PRP for the treatment
of chronic non-healing diabetic wounds under section 1862(a)(1)(A) of the
Social Security Act (the Act) for a duration of 20 weeks, when prepared by
devices whose Food and Drug Administration-cleared indications include the
management of exuding cutaneous wounds, such as diabetic ulcers.

**C. Nationally Non-Covered Indications**

Autologous PDGF for the treatment of chronic, non-healing cutaneous wounds,
and,

Becaplermin, a non-autologous growth factor for chronic, non-healing
subcutaneous wounds, and,

Autologous PRP for the treatment of acute surgical wounds when the autologous
PRP is applied directly to the closed incision, or for dehiscent wounds.

**D. Other**

Effective for services performed on or after April 13, 2021:

Coverage of autologous PRP for the treatment of chronic non-healing diabetic
wounds beyond 20 weeks will be determined by the local Medicare Administrative
Contractors (MACs).

Coverage of autologous PRP for the treatment of all other chronic non-healing
wounds will be determined by the local MACs under section 1862(a)(1)(A) of the
Act.

(This NCD last reviewed April 2021.)
Self-contained pacemaker monitors are accepted devices for monitoring cardiac
pacemakers. Accordingly, program payment may be made for the rental or
purchase of either of the following pacemaker monitors when a physician for a
patient prescribes it with a cardiac pacemaker:

**A. Digital Electronic Pacemaker Monitor**

This device provides the patient with an instantaneous digital readout of his
pacemaker pulse rate. Use of this device does not involve professional
services until there has been a change of five pulses (or more) per minute
above or below the initial rate of the pacemaker; when such change occurs, the
patient contacts his physician.

**B. Audible/Visible Signal Pacemaker Monitor**

This device produces an audible and visible signal which indicates the
pacemaker rate. Use of this device does not involve professional services
until a change occurs in these signals; at such time, the patient contacts his
physician.

**NOTE:** The design of the self-contained pacemaker monitor makes it possible
for the patient to monitor his pacemaker periodically and minimizes the need
for regular visits to the outpatient department of the provider.

Therefore, documentation of the medical necessity for pacemaker evaluation in
the outpatient department of the provider should be obtained where such
evaluation is employed in addition to the self-contained pacemaker monitor
used by the patient in his home.
Reimbursement may be made for the rental or purchase of a medically necessary
seat lift when prescribed by a physician for a patient with severe arthritis
of the hip or knee and patients with muscular dystrophy or other neuromuscular
diseases when it has been determined the patient can benefit therapeutically
from use of the device. In establishing medical necessity for the seat lift,
the evidence must show that the item is included in the physician's course of
treatment, that it is likely to effect improvement, or arrest or retard
deterioration in the patient's condition, and that the severity of the
condition is such that the alternative would be chair or bed confinement.

Coverage of seat lifts is limited to those types which operate smoothly, can
be controlled by the patient, and effectively assist a patient in standing up
and sitting down without other assistance. Excluded from coverage is the type
of lift which operates by a spring release mechanism with a sudden, catapult-
like motion and jolts the patient from a seated to a standing position. Limit
the payment for units which incorporate a recliner feature along with the seat
lift to the amount payable for a seat lift without this feature.
Blood glucose monitors are meter devices that read color changes produced on
specially treated reagent strips by glucose concentrations in the patient's
blood. The patient, using a disposable sterile lancet, draws a drop of blood,
places it on a reagent strip and, following instructions which may vary with
the device used, inserts it into the device to obtain a reading. Lancets,
reagent strips, and other supplies necessary for the proper functioning of the
device are also covered for patients for whom the device is indicated. Home
blood glucose monitors enable certain patients to better control their blood
glucose levels by frequently checking and appropriately contacting their
attending physician for advice and treatment. Studies indicate that the
patient's ability to carefully follow proper procedures is critical to
obtaining satisfactory results with these devices. In addition, the cost of
the devices, with their supplies, limits economical use to patients who must
make frequent checks of their blood glucose levels. Accordingly, coverage of
home blood glucose monitors is limited to patients meeting the following
conditions:

  1. The patient has been diagnosed as having diabetes;
  2. The patient's physician states that the patient is capable of being trained to use the particular device prescribed in an appropriate manner. In some cases, the patient may not be able to perform this function, but a responsible individual can be trained to use the equipment and monitor the patient to assure that the intended effect is achieved. This is permissible if the record is properly documented by the patient's physician; and
  3. The device is designed for home rather than clinical use.

There is also a blood glucose monitoring system designed especially for use by
those with visual impairments. The monitors used in such systems are identical
in terms of reliability and sensitivity to the standard blood glucose monitors
described above. They differ by having such features as voice synthesizers,
automatic timers, and specially designed arrangements of supplies and
materials to enable the visually impaired to use the equipment without
assistance.

These special blood glucose monitoring systems are covered under Medicare if
the following conditions are met:

  * The patient and device meet the three conditions listed above for coverage of standard home blood glucose monitors; and
  * The patient's physician certifies that he or she has a visual impairment severe enough to require use of this special monitoring system.

The additional features and equipment of these special systems justify a
higher reimbursement amount than allowed for standard blood glucose monitors.
Separately identify claims for such devices and establish a separate
reimbursement amount for them.
Studies do not demonstrate any advantage of IPV over that achieved with good
pulmonary care in the hospital environment and there are no studies in the
home setting. There are no data to support the effectiveness of the device.
Therefore, IPV in the home setting is not covered.
Pelvic floor electrical stimulation with a non-implantable stimulator is
covered for the treatment of stress and/or urge urinary incontinence in
cognitively intact patients who have failed a documented trial of pelvic
muscle exercise (PME) training.

A failed trial of PME training is defined as no clinically significant
improvement in urinary continence after completing 4 weeks of an ordered plan
of pelvic muscle exercises designed to increase periurethral muscle strength.
There is insufficient scientific or clinical evidence to consider this device
as reasonable and necessary for the treatment of wounds within the meaning of
1862(a)(1)(A) of the Social Security Act and will not be covered by Medicare.
Hydrophilic contact lenses are eyeglasses within the meaning of the exclusion
in 1862(a)(7) of the Social Security Act and are not covered when used in the
treatment of non-diseased eyes with spherical ametrophia, refractive
astigmatism, and/or corneal astigmatism. Payment may be made under the
prosthetic device benefit, however, for hydrophilic contact lenses when
prescribed for an aphakic patient.

Medicare Administrative Contractors are authorized to accept a Food and Drug
Administration (FDA) letter of approval or other FDA-published material as
evidence of FDA approval. (See 80.1 for coverage of a hydrophilic lens as a
corneal bandage.)
Not Covered

Electrical continence aids are in the experimental stage of development and
there is no valid scientific documentation of their effectiveness and safety.
Therefore, they are not covered under Medicare since they cannot be considered
to be reasonable and necessary for the treatment of an illness or injury or to
improve the functioning of a malformed body member as required by 1862(a)(1)
of the Act.
A scleral shell fits over the entire exposed surface of the eye as opposed to
a corneal contact lens which covers only the central non-white area
encompassing the pupil and iris. Where an eye has been rendered sightless and
shrunken by inflammatory disease, a scleral shell may, among other things,
obviate the need for surgical enucleation and prosthetic implant and act to
support the surrounding orbital tissue. In such a case, the device serves
essentially as an artificial eye. In this situation, payment may be made for a
scleral shell under 1861(s)(8) of the Act.

Scleral shells are occasionally used in combination with artificial tears in
the treatment of "dry eye" of diverse etiology. Tears ordinarily dry at a
rapid rate, and are continually replaced by the lacrimal gland. When the
lacrimal gland fails, the half-life of artificial tears may be greatly
prolonged by the use of the scleral contact lens as a protective barrier
against the drying action of the atmosphere. Thus, the difficult and sometimes
hazardous process of frequent installation of artificial tears may be avoided.
The lens acts in this instance to substitute, in part, for the functioning of
the diseased lacrimal gland and would be covered as a prosthetic device in the
rare case when it is used in the treatment of "dry eye."
**160.6  Carotid Sinus Nerve Stimulator (RETIRED)  
_(Rev. 11892; Issued: 03-09-23; Effective: 04-10-23; Implementation:
04-10-23)**

_

Effective December 18, 2014, NCD 160.6 is _retired._
Electronic speech aids are covered under Part B as prosthetic devices when the
patient has had a laryngectomy or his larynx is permanently inoperative.
Rev. 161, Issued: 02-06-14, Effective: 08-13-13, Implementation: 07-07-14)
Intraocular lens implantation services, as well as the lens itself, may be
covered if reasonable and necessary for the individual. Implantation services
may include hospital, surgical, and other medical services, including pre-
implantation ultrasound (A-scan) eye measurement of one or both eyes.
Two general classifications of electrical nerve stimulators are employed to
treat chronic intractable pain: peripheral nerve stimulators and central
nervous system stimulators.

**

A. Implanted Peripheral Nerve Stimulators

**

Payment may be made under the prosthetic device benefit for implanted
peripheral nerve stimulators. Use of this stimulator involves implantation of
electrodes around a selected peripheral nerve. The stimulating electrode is
connected by an insulated lead to a receiver unit which is implanted under the
skin at a depth not greater than 1/2 inch.

Stimulation is induced by a generator connected to an antenna unit which is
attached to the skin surface over the receiver unit. Implantation of
electrodes requires surgery and usually necessitates an operating room.

**NOTE:** Peripheral nerve stimulators may also be employed to assess a
patients suitability for continued treatment with an electric nerve
stimulator. As explained in 160.7.1, such use of the stimulator is covered as
part of the total diagnostic service furnished to the beneficiary rather than
as a prosthesis.

**

B. Central Nervous System Stimulators (Dorsal Column and Depth Brain
Stimulators)

**

The implantation of central nervous system stimulators may be covered as
therapies for the relief of chronic intractable pain, subject to the following
conditions:

**

1\. Types of Implantations

**

There are two types of implantations covered by this instruction:

  * Dorsal Column (Spinal Cord) Neurostimulation - The surgical implantation of neurostimulator electrodes within the dura mater (endodural) or the percutaneous insertion of electrodes in the epidural space is covered.
  * Depth Brain Neurostimulation - The stereotactic implantation of electrodes in the deep brain (e.g., thalamus and periaqueductal gray matter) is covered.

**

2\. Conditions for Coverage

**

No payment may be made for the implantation of dorsal column or depth brain
stimulators or services and supplies related to such implantation, unless all
of the conditions listed below have been met:

  * The implantation of the stimulator is used only as a late resort (if not a last resort) for patients with chronic intractable pain;
  * With respect to item a, other treatment modalities (pharmacological, surgical, physical, or psychological therapies) have been tried and did not prove satisfactory, or are judged to be unsuitable or contraindicated for the given patient;
  * Patients have undergone careful screening, evaluation and diagnosis by a multidisciplinary team prior to implantation. (Such screening must include psychological, as well as physical evaluation);
  * All the facilities, equipment, and professional and support personnel required for the proper diagnosis, treatment training, and follow up of the patient (including that required to satisfy item c) must be available; and
  * Demonstration of pain relief with a temporarily implanted electrode precedes permanent implantation.

Medicare Administrative Contractors may find it helpful to work with Quality
Improvement Organizations to obtain the information needed to apply these
conditions to claims.
**180.2 - Enteral and Parenteral Nutritional Therapy (RETIRED)  
_(Rev. 11892; Issued: 03-09-23; Effective: 04-10-23; Implementation:
04-10-23)**

_

Effective January 1, 2022, the Centers for Medicare & Medicaid Services
determined that no national coverage determination (NCD) is appropriate at
this time for Enteral and Parenteral Nutritional Therapy. In the absence of an
NCD, coverage determinations will be made by the Medicare Administrative
Contractors under 1862(a)(1)(A) of the Social Security Act.
The use of spinal cord electrical stimulators, rectal electrical stimulators,
and bladder wall stimulators is not considered reasonable and necessary.
Therefore, no program payment may be made for these devices or for their
implant.
The implantation of a phrenic nerve stimulator is covered for selected
patients with partial or complete respiratory insufficiency.