Persius/hicric huggingface dataset:
**CIM 35-57**

Electroencephalographic (EEG) monitoring is a safe and reliable technique for
the assessment of gross cerebral blood flow during general anesthesia and is
covered under Medicare. Very characteristic changes in the EEG occur when
cerebral perfusion is inadequate for cerebral function. EEG monitoring as an
indirect measure of cerebral perfusion requires the expertise of an
electroencephalographer, a neurologist trained in EEG, or an advanced EEG
technician for its proper interpretation.

The EEG monitoring may be covered routinely in carotid endarterectomies and in
other neurological procedures where cerebral perfusion could be reduced. Such
other procedures might include aneurysm surgery where hypotensive anesthesia
is used or other cerebral vascular procedures where cerebral blood flow may be
interrupted.
**160.9  Electroencephalographic (EEG) Monitoring During Open-Heart Surgery
(RETIRED)  
_(Rev. 11892; Issued: 03-09-23; Effective: 04-10-23; Implementation:
04-10-23)**

_

Effective December 18, 2014, NCD 160.9 is _retired._
TDD is performed on an inpatient basis, and the inpatient stay is covered for
patients admitted for treatment in advance of a kidney transplant as well as
for those receiving it post-transplant. TDD is a covered technique when
furnished to a kidney transplant recipient or an individual approved to
receive kidney transplantation in a hospital approved to perform kidney
transplantation.
**

B. Indications

**

Apheresis is covered for the following indications:

  * Plasma exchange for acquired myasthenia gravis;
  * Leukapheresis in the treatment of leukemia;
  * Plasmapheresis in the treatment of primary macroglobulinemia (Waldenstrom);
  * Treatment of hyperglobulinemias, including (but not limited to) multiple myelomas, cryoglobulinemia and hyperviscosity syndromes;
  * Plasmapheresis or plasma exchange as a last resort treatment of thromobotic thrombocytopenic purpura (TTP);
  * Plasmapheresis or plasma exchange in the last resort treatment of life threatening rheumatoid vasculitis;
  * Plasma perfusion of charcoal filters for treatment of pruritis of cholestatic liver disease;
  * Plasma exchange in the treatment of Goodpasture's Syndrome;
  * Plasma exchange in the treatment of glomerulonephritis associated with antiglomerular basement membrane antibodies and advancing renal failure or pulmonary hemorrhage;
  * Treatment of chronic relapsing polyneuropathy for patients with severe or life threatening symptoms who have failed to respond to conventional therapy;
  * Treatment of life threatening scleroderma and polymyositis when the patient is unresponsive to conventional therapy;
  * Treatment of Guillain-Barre Syndrome; and
  * Treatment of last resort for life threatening systemic lupus erythematosus (SLE) when conventional therapy has failed to prevent clinical deterioration.

**

C. Settings

**

Apheresis is covered only when performed in a hospital setting (either
inpatient or outpatient) or in a nonhospital setting, e.g., a physician
directed clinic when the following conditions are met:

  * A physician (or a number of physicians) is present to perform medical services and to respond to medical emergencies at all times during patient care hours;
  * Each patient is under the care of a physician; and
  * All nonphysician services are furnished under the direct, personal supervision of a physician.
**50.6 - Tinnitus Masking (RETIRED)  
(Rev. 11892; Issued: 03-09-23; Effective: 04-10-23; Implementation:04-10-23)**

_This section of the NCD Manual was retired December 18, 2014.
The application of chelation therapy using ethylenediamine-tetra-acetic acid
(EDTA) for the treatment and prevention of atherosclerosis is controversial.
There is no widely accepted rationale to explain the beneficial effects
attributed to this therapy. Its safety is questioned and its clinical
effectiveness has never been established by well designed, controlled clinical
trials. It is not widely accepted and practiced by American physicians. EDTA
chelation therapy for atherosclerosis is considered experimental. For these
reasons, EDTA chelation therapy for the treatment or prevention of
atherosclerosis is not covered Some practitioners refer to this therapy as
chemoendarterectomy and may also show a diagnosis other than atherosclerosis,
such as arteriosclerosis or calcinosis. Claims employing such variant terms
should also be denied under this section.
Psoriasis is a chronic skin disease, for which several conventional methods of
treatment have been recognized as covered. These include topical application
of steroids or other drugs; ultraviolet light (actinotherapy); and coal tar
alone or in combination with ultraviolet B light (Goeckerman treatment).

A newer treatment for psoriasis uses a psoralen derivative drug in combination
with ultraviolet A light, known as PUVA. PUVA therapy is covered for treatment
of intractable, disabling psoriasis, but only after the psoriasis has not
responded to more conventional treatment. The Medicare Administrative
Contractor should document this before paying for PUVA therapy.

In addition, reimbursement for PUVA therapy should be limited to amounts paid
for other types of photochemotherapy; ordinarily, payment should not be
allowed for more than 30 days of treatment, unless improvement is documented.
Melodic intonation therapy is a covered service only for nonfluent aphasic
patients unresponsive to conventional therapy, and only when the conditions
for coverage of speech pathology services are met.
**100.9 - Implantation of Anti-Gastroesophageal Reflux Device (RETIRED)  
_(Rev. 11892; Issued: 03-09-23; Effective: 04-10-23; Implementation: 04-10-23)

**_

Effective January 1, 2021, the Centers for Medicare & Medicaid Services
determined that no national coverage determination (NCD) is appropriate at
this time for FDG PET for Implantation of Gastrointestinal Reflux Devices. 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.
Use of the CBGCD is covered for short-term management of insulin dependent
diabetics in crisis situations, in a hospital inpatient setting, and only
under the direction of specially trained medical personnel.
These pretransplant transfusions are covered under Medicare without a specific
limitation on the number of transfusions, subject to the normal Medicare blood
deductible provisions. Where blood is given directly to the transplant
patient; e.g., in the case of donor specific transfusions, the blood is
considered replaced for purposes of the blood deductible provisions.
Electrotherapy for the treatment of facial nerve paralysis, commonly known as
Bell's Palsy, is not covered under Medicare because its clinical effectiveness
has not been established.
**

Indications

**

Generally speaking, collagen crosslink testing is useful mostly in "fast
losers" of bone. The age when these bone markers can help direct therapy is
often pre-Medicare. By the time a fast loser of bone reaches age 65, she will
most likely have been stabilized by appropriate therapy or have lost so much
bone mass that further testing is useless. Coverage for bone marker assays may
be established, however, for younger Medicare beneficiaries and for those men
and women who might become fast losers because of some other therapy such as
glucocorticoids. Safeguards should be incorporated to prevent excessive use of
tests in patients for whom they have no clinical relevance.

Collagen crosslinks testing is used to:

  1. Identify individuals with elevated bone resorption, who have osteoporosis in whom response to treatment is being monitored;
  2. Predict response (as assessed by bone mass measurements) to FDA approved antiresorptive therapy in postmenopausal women; and
  3. Assess response to treatment of patients with osteoporosis, Paget's disease of the bone, or risk for osteoporosis where treatment may include FDA approved antiresorptive agents, anti-estrogens or selective estrogen receptor moderators.

**

Limitations

**

Because of significant specimen to specimen collagen crosslink physiologic
variability (15-20%), current recommendations for appropriate utilization
include: one or two base-line assays from specified urine collections on
separate days; followed by a repeat assay about three months after starting
anti-resorptive therapy; followed by a repeat assay in 12 months after the
three-month assay; and thereafter not more than annually, unless there is a
change in therapy in which circumstance an additional test may be indicated
three months after the initiation of new therapy.

Some collagen crosslink assays may not be appropriate for use in some
disorders, according to FDA labeling restrictions.

Note: Scroll down for links to the quarterly Covered Code Lists (including
narrative).
**B. Nationally Covered Indications**

Effective for services performed on or after July 1, 1999, coverage is
provided for the use of ECP for patients who have been diagnosed with
disabling angina (Class III or Class IV, Canadian Cardiovascular Society
Classification or equivalent classification) who, in the opinion of a
cardiologist or cardiothoracic surgeon, are not readily amenable to surgical
intervention, such as PTCA or cardiac bypass, because:

  1. Their condition is inoperable, or at high risk of operative complications or post-operative failure;
  2. Their coronary anatomy is not readily amenable to such procedures; or
  3. They have co-morbid states which create excessive risk.

A full course of therapy usually consists of 35 one-hour treatments, which may
be offered once or twice daily, usually 5 days per week. The patient is placed
on a treatment table where their lower trunk and lower extremities are wrapped
in a series of three compressive air cuffs which inflate and deflate in
synchronization with the patient's cardiac cycle.

During diastole the three sets of air cuffs are inflated sequentially (distal
to proximal) compressing the vascular beds within the muscles of the calves,
lower thighs and upper thighs. This action results in an increase in diastolic
pressure, generation of retrograde arterial blood flow and an increase in
venous return. The cuffs are deflated simultaneously just prior to systole,
which produces a rapid drop in vascular impedance, a decrease in ventricular
workload and an increase in cardiac output.

The augmented diastolic pressure and retrograde aortic flow appear to improve
myocardial perfusion, while systolic unloading appears to reduce cardiac
workload and oxygen requirements. The increased venous return coupled with
enhanced systolic flow appears to increase cardiac output. As a result of this
treatment, most patients experience increased time until onset of ischemia,
increased exercise tolerance, and a reduction in the number and severity of
anginal episodes. Evidence was presented that this effect lasted well beyond
the immediate post-treatment phase, with patients symptom-free for several
months to two years. This procedure must be done under direct supervision of a
physician.

**C. Nationally Non-Covered Indications**

All other cardiac conditions not otherwise specified as nationally covered for
the use of ECP remain nationally non-covered.

(This NCD last reviewed March 2006.)
**

Indications

**

Blood glucose values are often necessary for the management of patients with
diabetes mellitus, where hyperglycemia and hypoglycemia are often present.
They are also critical in the determination of control of blood glucose levels
in the patient with impaired fasting glucose (FPG 110-125 mg/dL), the patient
with insulin resistance syndrome and/or carbohydrate intolerance (excessive
rise in glucose following ingestion of glucose or glucose sources of food), in
the patient with a hypoglycemia disorder such as nesidioblastosis or
insulinoma, and in patients with a catabolic or malnutrition state. In
addition to those conditions already listed, glucose testing may be medically
necessary in patients with tuberculosis, unexplained chronic or recurrent
infections, alcoholism, coronary artery disease (especially in women), or
unexplained skin conditions (including pruritis, local skin infections,
ulceration and gangrene without an established cause).

Many medical conditions may be a consequence of a sustained elevated or
depressed glucose level. These include comas, seizures or epilepsy, confusion,
abnormal hunger, abnormal weight loss or gain, and loss of sensation.
Evaluation of glucose may also be indicated in patients on medications known
to affect carbohydrate metabolism.

Effective January 1, 2005, the Medicare law expanded coverage to diabetic
screening services. Some forms of blood glucose testing covered under this
national coverage determination may be covered for screening purposes subject
to specified frequencies. See 42 CFR 410.18 and section 90, chapter 18, of the
[Claims Processing Manual](https://www.cms.gov/Regulations-and-
Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-
Items/CMS018912.html?DLPage=1&DLSort=0&DLSortDir=ascending), for a full
description of this screening benefit.

**

Limitations

**

Frequent home blood glucose testing by diabetic patients should be encouraged.
In stable, non-hospitalized patients who are unable or unwilling to do home
monitoring, it may be reasonable and necessary to measure quantitative blood
glucose up to four times annually.

Depending upon the age of the patient, type of diabetes, degree of control,
complications of diabetes, and other co-morbid conditions, more frequent
testing than four times annually may be reasonable and necessary.

In some patients presenting with nonspecific signs, symptoms, or diseases not
normally associated with disturbances in glucose metabolism, a single blood
glucose test may be medically necessary. Repeat testing may not be indicated
unless abnormal results are found or unless there is a change in clinical
condition. If repeat testing is performed, a specific diagnosis code (e.g.,
diabetes) should be reported to support medical necessity. However, repeat
testing may be indicated where results are normal in patients with conditions
where there is a confirmed continuing risk of glucose metabolism abnormality
(e.g., monitoring glucocorticoid therapy).

Note: Scroll down for links to the quarterly Covered Code Lists (including
narrative).
The intraoperative ventricular mapping procedure is covered under Medicare
only for the uses and medical conditions described below:

  * Localize accessory pathways associated with the Wolff-Parkinson-White (WPW) and other preexcitation syndromes;
  * Map the sequence of atrial and ventricular activation for drug-resistant supraventricular tachycardias;
  * Delineate the anatomical course of His bundle and/or bundle branches during corrective cardiac surgery for congenital heart diseases; and
  * Direct the surgical treatment of patients with refractory ventricular tachyarrhythmias.
**

Indications

**

Glycated hemoglobin/protein testing is widely accepted as medically necessary
for the management and control of diabetes. It is also valuable to assess
hyperglycemia, a history of hyperglycemia or dangerous hypoglycemia. Glycated
protein testing may be used in place of glycated hemoglobin in the management
of diabetic patients, and is particularly useful in patients who have
abnormalities of erythrocytes such as hemolytic anemia or hemoglobinopathies.

**

Limitations

**

It is not considered reasonable and necessary to perform glycated hemoglobin
tests more often than every three months on a controlled diabetic patient to
determine whether the patient's metabolic control has been on average within
the target range. It is not considered reasonable and necessary for these
tests to be performed more frequently than once a month for diabetic pregnant
women. Testing for uncontrolled type one or two diabetes mellitus may require
testing more than four times a year. The above Description Section provides
the clinical basis for those situations in which testing more frequently than
four times per annum is indicated, and medical necessity documentation must
support such testing in excess of the above guidelines.

Many methods for the analysis of glycated hemoglobin show significant
interference from elevated levels of fetal hemoglobin or by variant hemoglobin
molecules. When the glycated hemoglobin assay is initially performed in these
patients, the laboratory may inform the ordering physician of a possible
analytical interference. Alternative testing, including glycated protein, for
example, fructosamine, may be indicated for the monitoring of the degree of
glycemic control in this situation. It is therefore conceivable that a patient
will have both a glycated hemoglobin and glycated protein ordered on the same
day. This should be limited to the initial assay of glycated hemoglobin, with
subsequent exclusive use of glycated protein. These tests are not considered
to be medically necessary for the diagnosis of diabetes.

Note: Scroll down for links to the quarterly Covered Code Lists (including
narrative).
**Indications**

Thyroid function tests are used to define hyper function, euthyroidism, or
hypofunction of thyroid disease. Thyroid testing may be reasonable and
necessary to:

  * Distinguish between primary and secondary hypothyroidism;
  * Confirm or rule out primary hypothyroidism;
  * Monitor thyroid hormone levels (for example, patients with goiter, thyroid nodules, or thyroid cancer);
  * Monitor drug therapy in patients with primary hypothyroidism;
  * Confirm or rule out primary hyperthyroidism; and
  * Monitor therapy in patients with hyperthyroidism.

Thyroid function testing may be medically necessary in patients with disease
or neoplasm of the thyroid and other endocrine glands. Thyroid function
testing may also be medically necessary in patients with metabolic disorders;
malnutrition; hyperlipidemia; certain types of anemia; psychosis and non-
psychotic personality disorders; unexplained depression; ophthalmologic
disorders; various cardiac arrhythmias; disorders of menstruation; skin
conditions; myalgias; and a wide array of signs and symptoms, including
alterations in consciousness; malaise; hypothermia; symptoms of the nervous
and musculoskeletal system; skin and integumentary system; nutrition and
metabolism; cardiovascular; and gastrointestinal system.

It may be medically necessary to do follow-up thyroid testing in patients with
a personal history of malignant neoplasm of the endocrine system and in
patients on long-term thyroid drug therapy.

**Limitations**

Testing may be covered up to two times a year in clinically stable patients;
more frequent testing may be reasonable and necessary for patients whose
thyroid therapy has been altered or in whom symptoms or signs of
hyperthyroidism or hypothyroidism are noted.

Note: Scroll down for links to the quarterly Covered Code Lists (including
narrative).
Indications

Digoxin levels may be performed to monitor drug levels of individuals
receiving digoxin therapy because the margin of safety between side effects
and toxicity is narrow or because the blood level may not be high enough to
achieve the desired clinical effect.

Clinical indications may include individuals on digoxin:

  * With symptoms, signs or electrocardiogram (ECG) suggestive of digoxin toxicity.
  * Taking medications that influence absorption, bioavailability, distribution, and/or elimination of digoxin.
  * With impaired renal, hepatic, gastrointestinal, or thyroid function.
  * With pH and/or electrolyte abnormalities.
  * With unstable cardiovascular status, including myocarditis.
  * Requiring monitoring of patient compliance.

Clinical indications may include individuals:

  * Suspected of accidental or intended overdose.
  * Who have an acceptable cardiac diagnosis (as listed) and for whom an accurate history of use of digoxin is unobtainable.

The value of obtaining regular serum digoxin levels is uncertain, but it may
be reasonable to check levels once yearly after a steady state is achieved. In
addition, it may be reasonable to check the level if:

  * Heart failure status worsens.
  * Renal function deteriorates.
  * Additional medications are added that could affect the digoxin level.
  * Signs or symptoms of toxicity develop.

Steady state will be reached in approximately 1 week in patients with normal
renal function, although 2-3 weeks may be needed in patients with renal
impairment. After changes in dosages or the addition of a medication that
could affect the digoxin level, it is reasonable to check the digoxin level
one week after the change or addition. Based on the clinical situation, in
cases of digoxin toxicity, testing may need to be done more than once a week.

Digoxin is indicated for the treatment of patients with heart failure due to
systolic dysfunction and for reduction of the ventricular response in patients
with atrial fibrillation or flutter. Digoxin may also be indicated for the
treatment of other supraventricular arrhythmias, particularly in the presence
of heart failure.

Limitations

This test is not appropriate for patients on digitoxin or treated with digoxin
FAB (fragment antigen binding) antibody.

Note: Scroll down for links to the quarterly Covered Code Lists (including
narrative).
Diagnostic endocardial electrical stimulation (EES), also called programmed
electrical stimulation of the heart, is covered under Medicare when used for
patients with severe cardiac arrhythmias.
The use of general or monitored anesthesia during transvenous cardiac
pacemaker surgery may be reasonable and necessary and therefore covered under
Medicare only if adequate documentation of medical necessity is provided on a
case-by-case basis. The Medicare Administrative Contractor obtains advice from
its medical consultants or from appropriate specialty physicians or groups in
its locality regarding the adequacy of documentation before deciding whether a
particular claim should be covered.

A second type of pacemaker surgery that is sometimes performed involves the
use of the thoracic method of implantation, which requires open surgery. Where
the thoracic method is employed, general anesthesia is always used and should
not require special medical documentation.