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

Refer to the Proposed Local Coverage Determination (LCD) DL38528, Hypoglossal
Nerve Stimulation for the Treatment of Obstructive Sleep Apnea, for reasonable
and necessary requirements.

The Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding
System (HCPCS) code(s) may be subject to National Correct Coding Initiative
(NCCI) edits. This information does not take precedence over NCCI edits.
Please refer to NCCI for correct coding guidelines and specific applicable
code combinations prior to billing Medicare.

**Coding  Guidelines**  
 **Implantation** of a Hypoglossal Nerve Stimulator (HSN) for treatment of OSA
CPT code:

  * **CPT code 64582** \- Open implantation of hypoglossal nerve neurostimulator array, pulse generator, and distal respiratory sensor electrode or electrode array

**Revision or replacement** of HSN for treatment of OSA is reported with:

  * **CPT code 64583** \- Revision or replacement of hypoglossal nerve neurostimulator array and distal respiratory sensor electrode or electrode array, including connection to existing pulse generator

**Reduced services** -Use modifier 52 for revision or replacement of either
the hypoglossal nerve stimulator electrode array or distal respiratory sensor,
and bill at a reduced rate.

**Removal** of HSN for treatment of OSA is reported with:

  * **CPT code 64584** \- Removal of hypoglossal nerve neurostimulator array, pulse generator, and distal respiratory sensor electrode array

**Reduced services** \- Use modifier 52 for removal of one or two components
of the hypoglossal nerve stimulator electrode array, pulse generator, or
distal respiratory sensor, and bill at a reduced rate.

**Coding Guidance**

  * Do not bill CPT code **64582** in conjunction with **64583, 64584, or 61888**
  * Do not bill CPT code **64583** in conjunction with **64582, 64584, or 61888**
  * Do not bill CPT code **64584** in conjunction with **64582, 64583, or 61888**

**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 diagnosis code(s).
Response to Comments: Hypoglossal Nerve Stimulation for the Treatment of
Obstructive Sleep Apnea

The evidence related to hypoglossal nerve stimulation (HNS) for treatment of
obstructive sleep apnea was presented at the Contractor Advisory Committee
(CAC) meetings in June 2019. The advice of the CAC members and Subject Matter
Experts was considered in the development of the proposed policy. The
following are the comment summaries and contractor responses for the Proposed
Local Coverage Determination (LCD) DL38312 (Hypoglossal Nerve Stimulation for
the Treatment of Obstructive Sleep Apnea) which was posted for comment and
presented at the September 9, 2019, Open Public Meeting. All comments were
reviewed and incorporated into the final LCD where applicable.
Billing and Coding: Hypoglossal Nerve Stimulation for the Treatment of
Obstructive Sleep Apnea

Refer to the Local Coverage Determination (LCD) L38310, Hypoglossal Nerve
Stimulation for the Treatment of Obstructive Sleep Apnea, for reasonable and
necessary requirements.

The Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding
System (HCPCS) code(s) may be subject to National Correct Coding Initiative
(NCCI) edits. This information does not take precedence over NCCI edits.
Please refer to NCCI for correct coding guidelines and specific applicable
code combinations prior to billing Medicare.

**Coding Guidelines**

**Implantation** of a Hypoglossal Nerve Stimulator (HSN) for treatment of OSA
CPT code:

  * **CPT code 64582** \- Open implantation of hypoglossal nerve neurostimulator array, pulse generator and distal respiratory sensor electrode or electrode array.  

**Revision or replacement** of HSN for treatment of OSA is reported with:

  * **CPT code 64583** \- Revision or replacement of hypoglossal nerve neurostimulator array and distal respiratory sensor electrode or electrode array, including connection to existing pulse generator.

**Reduced Services -** Use modifier 52 for revision or replacement of either
the hypoglossal nerve stimulator electrode array or distal respiratory sensor,
and bill at a reduced rate.  

**Removal** of HSN for treatment of OSA is reported with:

  * **CPT code 64584** \- Removal of hypoglossal nerve neurostimulator array, pulse generator, and distal respiratory sensor electrode or electrode array.  

**Reduced Services -** Use modifier 52 for removal of one or two components of
the hypoglossal nerve stimulator electrode array, pulse generator, or distal
respiratory sensor, and bill at a reduced rate  

**Coding Guidance**

  * Do not bill CPT code **64582** in conjunction with **64583 or 64584**
  * Do not bill CPT code **64583** in conjunction with **64582 or 64584**
  * Do not bill CPT code **64584** in conjunction with **64582 or 64583**

**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 diagnosis code(s).
Billing and Coding: Hypoglossal Nerve Stimulation for the Treatment of
Obstructive Sleep Apnea

Refer to the Local Coverage Determination (LCD) L38312, Hypoglossal Nerve
Stimulation for the Treatment of Obstructive Sleep Apnea, for reasonable and
necessary requirements.

The Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding
System (HCPCS) code(s) may be subject to National Correct Coding Initiative
(NCCI) edits. This information does not take precedence over NCCI edits.
Please refer to NCCI for correct coding guidelines and specific applicable
code combinations prior to billing Medicare.

**Coding Guidelines**

**Implantation** of a Hypoglossal Nerve Stimulator (HSN) for treatment of OSA
CPT code:

  * **CPT code 64582** \- Open implantation of hypoglossal nerve neurostimulator array, pulse generator and distal respiratory sensor electrode or electrode array.  

**Revision or replacement** of HSN for treatment of OSA is reported with:

  * **CPT code 64583** \- Revision or replacement of hypoglossal nerve neurostimulator array and distal respiratory sensor electrode or electrode array, including connection to existing pulse generator.

**Reduced Services -** Use modifier 52 for revision or replacement of either
the hypoglossal nerve stimulator electrode array or distal respiratory sensor,
and bill at a reduced rate.  

**Removal** of HSN for treatment of OSA is reported with:

  * **CPT code 64584** \- Removal of hypoglossal nerve neurostimulator array, pulse generator, and distal respiratory sensor electrode or electrode array.  

**Reduced Services -** Use modifier 52 for removal of one or two components of
the hypoglossal nerve stimulator electrode array, pulse generator, or distal
respiratory sensor, and bill at a reduced rate  

**Coding Guidance**

  * Do not bill CPT code **64582** in conjunction with **64583 or 64584**
  * Do not bill CPT code **64583** in conjunction with **64582 or 64584**
  * Do not bill CPT code **64584** in conjunction with **64582 or 64583**

**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 diagnosis code(s).
Billing and Coding: Routine Foot Care

Below is a summary of the expected coding and billing to be used when billing
for routine foot care that meets the criteria as established in the CMS
Internet Only Manual, _Benefit Policy Manual_ , Pub 100-02 Chapter 15, Section
290 linked in the Associated Documents section below.

Please note the clinical documentation must clearly show that the patient's
condition warrants a provider rendering these services in accordance with the
above instruction and failure to provide such professional services would be
hazardous to the beneficiary due to their underlying medical condition(s).
Failure to properly document the reasoning for the care rendered may result in
denial of the claim.

In addition, the beneficiary may have complicating diagnosis(es) that require
them to be under the care of a primary physician for the disease that is
causing the beneficiary to seek provider based routine foot care. For the
asterisked conditions, the name of the primary physician (must be a D.O. or
M.D.) who made the diagnosis, and the approximate date of the last visit
should be included in the record and entered on the appropriate claim forms or
electronic equivalent when billing Medicare per the Benefit Policy Manual
noted above. Please refer to the CMS website for instructions for billing
[Part A](https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-
MLN/MLNProducts/Downloads/837I-FormCMS-1450-ICN006926.pdf) and [Part
B](https://www.cms.gov/files/document/mln006976-medicare-billing-837p-form-
cms-1500.pdf) claims. There is also information on Noridian's website for JE
[Part B](https://med.noridianmedicare.com/web/jeb/topics/claim-
submission/cms-1500-crosswalk-emc-loops-segments) claims.

Routine foot care services are not restricted to podiatrists. These services
may be used by any certified physician or non-physician (NPP) specialty, in
keeping with State licensure, if applicable, to provide proper care in either
a Part A facility or physician's office.
Billing and Coding: Routine Foot Care

Below is a summary of the expected coding and billing to be used when billing
for routine foot care that meets the criteria as established in the CMS
Internet Only Manual, _Benefit Policy Manual_ , Pub 100-02 Chapter 15, Section
290 linked in the Associated Documents section below.

Please note the clinical documentation must clearly show that the patient's
condition warrants a provider rendering these services in accordance with the
above instruction and failure to provide such professional services would be
hazardous to the beneficiary due to their underlying medical condition(s).
Failure to properly document the reasoning for the care rendered may result in
denial of the claim.

In addition, the beneficiary may have complicating diagnosis(es) that require
them to be under the care of a primary physician for the disease that is
causing the beneficiary to seek provider based routine foot care. For the
asterisked conditions, the name of the primary physician (must be a D.O. or
M.D.) who made the diagnosis, and the approximate date of the last visit
should be included in the record and entered on the appropriate claim forms or
electronic equivalent when billing Medicare per the Benefit Policy Manual
noted above. Please refer to the CMS website for instructions for billing
[Part A](https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-
MLN/MLNProducts/Downloads/837I-FormCMS-1450-ICN006926.pdf) and [Part
B](https://www.cms.gov/files/document/mln006976-medicare-billing-837p-form-
cms-1500.pdf) claims. There is also information on Noridian's website for JF
[Part B](https://med.noridianmedicare.com/web/jfb/topics/claim-
submission/cms-1500-crosswalk-emc-loops-segments) claims.

Routine foot care services are not restricted to podiatrists. These services
may be used by any certified physician or non-physician (NPP) specialty, in
keeping with State licensure, if applicable, to provide proper care in either
a Part A facility or physician's office.
Response to Comments: Cardiology Non-emergent Outpatient Stress Testing

First Coast Service Options, Inc. (First Coast) received comment from within
the Medicare Administrative Contractor (MAC) Jurisdiction N (JN) for Florida,
Puerto Rico and the United States Virgin Islands, for the Proposed Local
Coverage Determination (LCD) DL38396 Cardiology Non-emergent Outpatient Stress
Testing.
Response to Comments: Hypoglossal Nerve Stimulation for the Treatment of
Obstructive Sleep Apnea

First Coast Service Options, Inc. (First Coast) received comments from Florida
and interested parties outside of the Medicare Administrative Contractor (MAC)
Jurisdiction N (JN) for Florida, Puerto Rico and the United States Virgin
Islands, for the Proposed Local Coverage Determination (LCD) DL38398
Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea.
The advice of the CAC members and Subject Matter Experts was considered in the
development of the proposed policy. All comments were reviewed and
incorporated into the final LCD where applicable.
Response to Comments: Hypoglossal Nerve Stimulation for Treatment of
Obstructive Sleep Apnea

As an important part of Medicare Local Coverage Determination (LCD)
development, National Government Services solicits comments from the provider
community and from members of the public who may be affected by or interested
in our LCDs. The purpose of the advice and comment process is to gain the
expertise and experience of those commenting.

We would like to thank those who suggested changes to the LCD for Hypoglossal
Nerve Stimulation for Treatment of Obstructive Sleep Apnea. The official
notice period for the final LCD begins on February 13, 2020 and the final
determination will become effective for services rendered on or after April 1,
2020.
Billing and Coding: MolDX: HLA Testing for Transplant Histocompatibility

Medicare covers the following solid organ transplants: kidney, heart, lung,
heart/lung, liver, pancreas, pancreas/kidney, and intestinal/multi-visceral.
Medicare also covers stem cell transplants for certain conditions.

Claims for CPT codes used to describe Human Leukocyte Antigen (HLA) testing
used for transplant histocompatibility testing will be denied. See below for
further explanation on correct billing for these services. This does not refer
to HLA testing for non-transplant services.

HLA testing for histocompatibility testing as part of transplantation are part
of solid organ acquisition services.

Services for organ transplants must be billed as described in the Centers for
Medicare and Medicaid Services (CMS) Internet-Only Manual, Pub 100-04,
Medicare Claims Processing Manual, Inpatient Hospital Billing, Chapter 3
Section 90 and as described in the Electronic Code of Federal Regulations,
Title 42, Public Health, Part 412 Prospective Payment Systems for Inpatient
Hospital Services. The acquisition costs of hearts, kidneys, livers, lungs,
pancreas, and intestines (or multivisceral organs) incurred by approved
transplantation centers are paid on a reasonable cost basis by approved
transplant centers; they are not billed as stand-alone laboratory services.

HLA typing is a component of the acquisition services for an allogeneic stem
cell transplant as well. Payment for these acquisition services is included in
the MS-DRG payment for the allogeneic stem cell transplant when the transplant
occurs in the inpatient setting and in the OPPS APC payment for the allogeneic
stem cell transplant when the transplant occurs in the outpatient setting. The
Medicare contractor does not make separate payment for these acquisition
services, because hospitals may bill and receive payment only for services
provided to the Medicare beneficiary who is the recipient of the stem cell
transplant and whose illness is being treated with the stem cell transplant.
Unlike the acquisition costs of solid organs for transplant (e.g., hearts and
kidneys), which are paid on a reasonable cost basis, acquisition costs for
allogeneic stem cells are included in prospective payment.

Acquisition charges do not apply to autologous transplants.

HLA CPT codes **_unrelated to transplant testing_ **have coverage as outlined
in the following Local Coverage Determinations (LCDs):

  * CPT 81381-The MolDX: Pharmacogenomics Testing L38335 LCD addresses limited coverage for gene-drug interactions.

  * CPT 81383 - The MolDX: HLA-DQB1*06:02 Testing for Narcolepsy L36551 LCD addresses non-coverage of HLA-DQB1*06:02 typing for the diagnosis or management of narcolepsy.
Billing and Coding: MolDX: HLA Testing for Transplant Histocompatibility

Medicare covers the following solid organ transplants: kidney, heart, lung,
heart/lung, liver, pancreas, pancreas/kidney, and intestinal/multi-visceral.
Medicare also covers stem cell transplants for certain conditions.

Claims for CPT codes used to describe Human Leukocyte Antigen (HLA) testing
used for transplant histocompatibility testing will be denied. See below for
further explanation on correct billing for these services. This does not refer
to HLA testing for non-transplant services.

HLA testing for histocompatibility testing as part of transplantation are part
of solid organ acquisition services.

Services for organ transplants must be billed as described in the Centers for
Medicare and Medicaid Services (CMS) Internet-Only Manual, Pub 100-04,
Medicare Claims Processing Manual, Inpatient Hospital Billing, Chapter 3
Section 90 and as described in the Electronic Code of Federal Regulations,
Title 42, Public Health, Part 412 Prospective Payment Systems for Inpatient
Hospital Services. The acquisition costs of hearts, kidneys, livers, lungs,
pancreas, and intestines (or multivisceral organs) incurred by approved
transplantation centers are paid on a reasonable cost basis by approved
transplant centers; they are not billed as stand-alone laboratory services.

HLA typing is a component of the acquisition services for an allogeneic stem
cell transplant as well. Payment for these acquisition services is included in
the MS-DRG payment for the allogeneic stem cell transplant when the transplant
occurs in the inpatient setting and in the OPPS APC payment for the allogeneic
stem cell transplant when the transplant occurs in the outpatient setting. The
Medicare contractor does not make separate payment for these acquisition
services, because hospitals may bill and receive payment only for services
provided to the Medicare beneficiary who is the recipient of the stem cell
transplant and whose illness is being treated with the stem cell transplant.
Unlike the acquisition costs of solid organs for transplant (e.g., hearts and
kidneys), which are paid on a reasonable cost basis, acquisition costs for
allogeneic stem cells are included in prospective payment.

Acquisition charges do not apply to autologous transplants.

HLA CPT codes **_unrelated to transplant testing_ **have coverage as outlined
in the following Local Coverage Determinations (LCDs):

  * CPT 81381- The MolDX: Pharmacogenomics Testing L38337 LCD addresses limited coverage for gene-drug interactions.
  * CPT 81383 - The MolDX: HLA-DQB1*06:02 Testing for Narcolepsy L36544 LCD addresses non-coverage of HLA-DQB1*06:02 typing for the diagnosis or management of narcolepsy.
Response to Comments: MolDX: Pigmented Lesion Assay

The comment period for the Local Coverage Determination (LCD) MolDX: Pigmented
Lesion Assay (DL38178) began on 04/25/2019 and ended on 6/09/19. The comments
below were received from the provider community. The notice period for L38178
begins on 02/27/2020 and will become effective on 04/12/2020.
Billing and Coding: MolDX: Pigmented Lesion Assay

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Pigmented
Lesion Assay L38178.

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

  * Select the appropriate CPT code
  * Enter 1 unit of service (UOS)
  * Enter the app 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: Stereotactic Radiosurgery (SRS) and Stereotactic Body
Radiation Therapy

First Coast Service Options, Inc. (First Coast) received no comments for the
Proposed Local Coverage Determination (LCD) L33410 and related Article:
Billing and Coding A57275.
Billing and Coding: Transanal Endoscopic Surgery (TES)

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for Transanal
Endoscopic Surgery (TES) L38551 _._
Billing and Coding: Transurethral Waterjet Ablation of the Prostate

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) Transurethral Waterjet
Ablation of the Prostate L38549. 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.

**Utilization Parameters**

****

**Documentation Requirements**

****

    1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
    2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
    3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.
Response to Comments: MolDX: Repeat Germline Testing

The comment period for the MolDX: Repeat Germline Testing DL38274 Local
Coverage Determination (LCD) began on 10/7/19 and ended on 11/21/19 _._ The
notice period for LCD L38274 begins on 4/16/20 and will become effective on
5/31/20 _._ The comments below were received from the provider community.
Billing and Coding: MolDX: Repeat Germline Testing

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Repeat
Germline Testing L38274.