Persius/hicric huggingface dataset:
Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM)

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L38662 Implantable Continuous Glucose Monitors
(I-CGM). Please refer to the LCD for reasonable and necessary requirements.

**Coding Guidance**

**Implantation** of an implantable continuous glucose monitor (I-CGM) that
meets the appropriate criteria as mentioned in LCD L38662 Implantable
Continuous Glucose Monitors (I-CGM) is reported with:

**CPT code 0446T** \- Creation of subcutaneous pocket with insertion of
implantable interstitial glucose sensor, including system activation and
patient training  

**Removal** of an I-CGM is reported with:

  * **CPT code 0447T** \- Removal of implantable interstitial glucose sensor from subcutaneous pocket via incision

**Removal with immediate subsequent replacement** of an I-CGM is reported with
**:**

****

  * **CPT code 0448T** \- Removal of implantable interstitial glucose sensor with creation of subcutaneous pocket at different anatomic site and insertion of new implantable sensor, including system activation



**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.

**Documentation Requirements**

****

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

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) DL38657 Implantable Continuous Glucose Monitors
(I-CGM). Please refer to the LCD for reasonable and necessary requirements.  
  
**Coding Guidance**

**Implantation** of an implantable continuous glucose monitor (I-CGM) that
meets the appropriate criteria as mentioned in LCD DL38657 Implantable
Continuous Glucose Monitors (I-CGM) is reported for either the 90 day or 180
day implantable sensor.

**For 90 day implantable glucose sensor report:**

  * CPT code 0446T - Creation of subcutaneous pocket with insertion of implantable interstitial glucose sensor, including system activation and patient training

**Removal** of an I-CGM is reported with:

  * CPT code 0447T - Removal of implantable interstitial glucose sensor from subcutaneous pocket via incision

**Removal with immediate subsequent replacement** of an I-CGM is reported
with:

  * CPT code 0448T - Removal of implantable interstitial glucose sensor with creation of subcutaneous pocket at different anatomic site and insertion of new implantable sensor, including system activation

**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.  
  
**Documentation Requirements**

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

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L38664 Implantable Continuous Glucose Monitors
(I-CGM). 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.

When coding 0446T, 0447T, and 0448T they are in relation to the 90 day
monitors.

**Documentation Requirements  **

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

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) DL38659 Implantable Continuous Glucose Monitors
(I-CGM). Please refer to the LCD for reasonable and necessary requirements.  
  
**Coding Guidance**

**Implantation** of an implantable continuous glucose monitor (I-CGM) that
meets the appropriate criteria as mentioned in LCD DL38659 Implantable
Continuous Glucose Monitors (I-CGM) is reported for either the 90 day or 180
day implantable sensor.

**For 90 day implantable glucose sensor report:**

  * CPT code 0446T - Creation of subcutaneous pocket with insertion of implantable interstitial glucose sensor, including system activation and patient training

**Removal** of an I-CGM is reported with:

  *  CPT code 0447T - Removal of implantable interstitial glucose sensor from subcutaneous pocket via incision

**Removal with immediate subsequent replacement** of an I-CGM is reported
with:

  * CPT code 0448T - Removal of implantable interstitial glucose sensor with creation of subcutaneous pocket at different anatomic site and insertion of new implantable sensor, including system activation

**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.  
  
**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: Transcranial Magnetic Stimulation

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 draft of the Transcranial Magnetic Stimulation LCD.

Although NGS did not receive any comments regarding the use of Transcranial
Magnetic Stimulation (TMS) for Obsessive Compulsive Disorder (OCD), comments
were received on practitioners for this service.

The official notice period for the final LCD begins on 06/11/2020, and the
final determination will become effective on 08/01/2020.
Billing and Coding: Computed Tomography Cerebral Perfusion Analysis (CTP)

This article contains coding and other guidelines that complement the Local
Coverage Determination (LCD) for Computed Tomography Cerebral Perfusion
Analysis (CTP).

**Coding Information:**

Procedure codes may be subject to National Correct Coding Initiative (NCCI)
edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to
billing Medicare.

For services requiring a referring/ordering physician, the name and NPI of the
referring/ordering physician must be reported on the claim.

A claim submitted without a valid ICD-10-CM diagnosis code will be returned to
the provider as an incomplete claim under Section 1833(e) of the Social
Security Act.

The diagnosis code(s) must best describe the patient's condition for which the
service was performed. For diagnostic tests, report the result of the test if
known; otherwise the symptoms prompting the performance of the test should be
reported.  
  

**Documentation Requirements:**

The patient's medical record must contain documentation that fully supports
the medical necessity for services included within the attached LCD. (See
"Indications and Limitations of Coverage.") This documentation includes, but
is not limited to, relevant medical history, physical examination, and results
of pertinent diagnostic tests or procedures.

The documentation of the study requires a formal written report, with clear
identifying demographics, the name of the interpreting provider, the reason
for the tests, an interpretive report and copies of images. The computerized
image reconstruction data should also be maintained.
Response to Comments: MolDX: Pharmacogenomics Testing

The comment period for the MolDX: Pharmacogenomics Testing DL38294 Local
Coverage Determination (LCD) began on 10/7/19 and ended on 11/21/19. The
comments below were received from the provider community. The notice period
for MolDX: Next Pharmacogenomics Testing L38294 begins on 6/11/20 and will
become effective on 7/26/20.
Response to Comments: MolDX: Repeat Germline Testing

The comment period for the MolDX: Repeat Germline Testing DL38351 Local
Coverage Determination (LCD) began on 10/22/19 and ended on 12/06/19 _._ The
notice period for LCD L38351 begins on 06/18/20 and will become effective on
08/03/20 _._ The comments below were received from the provider community.
Response to Comments: MolDX: Repeat Germline Testing

The comment period for the MolDX: Repeat Germline Testing DL38353 Local
Coverage Determination (LCD) began on 10/22/19 and ended on 12/06/19 _._ The
notice period for LCD L38353 begins on 06/18/20 and will become effective on
08/03/20 _._ The comments below were received from the provider community.
Response to Comments: MolDX: Pharmacogenomics Testing

The comment period for the MolDX: Pharmacogenomics Testing DL38394 Local
Coverage Determination (LCD) began on 10/30/19 and ended on 12/15/19. The
comments below were received from the provider community. The notice period
for MolDX: Next Pharmacogenomics Testing L38294 begins on 06/18/2020 thru
08/02/2020 and will become effective on 08/03/2020.
Billing and Coding: MolDX: Prognostic and Predictive Molecular Classifiers for
Bladder Cancer

The information in this article contains billing, coding, or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Prognostic
and Predictive Molecular Classifiers for Bladder Cancer L38647.

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

  * Select the appropriate CPT code
  * Enter 1 unit of service (UOS)
  * Enter the appropriate DEX Z-Code 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
    * Item 19 for paper claim
  * Enter the appropriate DEX Z-Code 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

**NOTE:** When entering the DEX Z-Code on the SV101-7 documentation field for
Part B claims please do not add additional characters and/or information on
the line.
Billing and Coding: MolDX: Phenotypic Biomarker Detection from Circulating
Tumor Cells

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Phenotypic
Biomarker Detection from Circulating Tumor Cells L38643

In accordance with the related LCD , the following tests are reasonable and
necessary:

  * Biocept Target Selector HER2 Assay
  * Androgen Receptor Variant (AR-V7) Protein Test

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

  * Select CPT code 81479
  * Enter 1 unit of service (UOS)
  * Enter the appropriate DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part B claim field/types: 
    * Loop 2400 or SV101-7 for the 5010A1 837P
    * Box 19 for paper claim
  * Enter the appropriate DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types: 
    * Line SV202-7 for 837I electronic claim
    * Block 80 for the UB04 claim form
  * Select the appropriate ICD-10-CM code
Billing and Coding: MolDX: Phenotypic Biomarker Detection from Circulating
Tumor Cells

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Phenotypic
Biomarker Detection from Circulating Tumor Cells L38645

In accordance with the LCD , the following tests are reasonable and necessary:

  * Biocept Target Selector HER2 Assay
  * Androgen Receptor Variant (AR-V7) Protein Test

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

  * Select CPT code 81479
  * Enter 1 unit of service (UOS)
  * Enter the appropriate DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part B claim field/types: 
    * Loop 2400 or SV101-7 for the 5010A1 837P
    * Item 19 for paper claim
  * Enter the appropriate DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types: 
    * Line SV202-7 for 837I electronic claim
    * Block 80 for the UB04 claim form
  * Select the appropriate ICD-10-CM code
Billing and Coding: MolDX: Prognostic and Predictive Molecular Classifiers for
Bladder Cancer

The information in this article contains billing, coding, or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Prognostic
and Predictive Molecular Classifiers for Bladder Cancer L38649.  

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

  * Select the appropriate CPT code
  * Enter 1 unit of service (UOS)
  * Enter the appropriate DEX Z-Code 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
    * Item 19 for paper claim
  * Enter the appropriate DEX Z-Code 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

**NOTE:** When entering the DEX Z-Code on the SV101-7 documentation field for
Part B claims please do not add additional characters and/or information on
the line.
Billing and Coding: Guardant360

Coverage will continue on a case by case basis utilizing the following
criteria until such time a more comprehensive non-proprietary local coverage
determination can be developed.

**Guardant360 ** remains covered for patients with non-CNS originated solid
tumors who meet the criteria of NCD 90.2 when the following conditions are
met:

Patient has been diagnosed with a recurrent, relapsed, refractory, metastatic,
or advanced solid tumor that did not originate from the central nervous
system. Patients who would meet all of the indications on the FDA label for
larotrectinib if they are found to have an NTRK mutation may be considered to
have advanced cancer, **and**

  * Patient has not previously been tested with the Guardant360 test for the same primary cancer. For a patient who has been tested previously using Guardant360 for a cancer, that patient may only be tested again when the patient has a new primary cancer diagnosis. In a patient with previously tested primary cancer, who has evidence of new malignant growth, that growth may be considered to be a different primary cancer if it does not originate from the same cell line or it is physiologically different enough that it responds differently to treatment than the previously tested cancer, **and**
  * Patient is untreated for the primary cancer being tested or the patient is not responding to treatment (e.g. progression or new lesions on treatment), **and**
  * The patient has decided to seek further cancer treatment with the following conditions:
    * The patient is a candidate for further treatment with a drug that is either FDA-approved for that patient's cancer, or has an NCCN 1 or NCCN 2A recommendation for that patient's cancer, **and**
    * The FDA-approved indication or NCCN recommendation is based upon information about the presence or absence of a genetic biomarker tested for in the Guardant360 assay, **and**
  * Tissue-based CGP is infeasible (i.e., quantity not sufficient for tissue-based CGP or invasive biopsy is medically contraindicated) **or** specifically in NSLC Tissue-based CGP has shown no actionable mutations.

If no alteration is detected by Guardant360 or if ctDNA is insufficient/not
detected, tissue-based genotyping should be considered.
Response to Comments: Percutaneous Vertebral Augmentation (PVA) for Vertebral
Compression Fracture (VCF)

The following are the comment summaries and contractor responses for the
Novitas Solutions Proposed Local Coverage Determination (LCD) DL35130
Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture
(VCF) which was posted for comment on December 26, 2019 and presented at the
Open Meeting on January 16, 2020. All comments were reviewed and incorporated
into the final LCD where applicable.
Response to Comments: MolDX Pharmacogenomics Testing (DL38435)

The comments in this document reflect all the comments sent to all the MACs in
the MolDx project for the Draft Local Determination (LCD): MolDX:
Pharmacogenomics Testing.
Billing and Coding: MolDX: Phenotypic Biomarker Detection from Circulating
Tumor Cells

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Phenotypic
Biomarker Detection from Circulating Tumor Cells L38678.

In accordance with the related LCD, the following test is reasonable and
necessary:

  * Biocept Target Selector HER2 Assay
  * Androgen Receptor Variant (AR-V7) Protein Test

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

  * Select CPT code 81479
  * Enter 1 unit of service (UOS)
  * Enter the appropriate DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part B claim field/types: 
    * Loop 2400 or SV101-7 for the 5010A1 837P
    * Box 19 for paper claim
  * Enter the appropriate DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types: 
    * Line SV202-7 for 837I electronic claim
    * Block 80 for the UB04 claim form
  * Select the appropriate ICD-10-CM code
Billing and Coding: Transurethral Waterjet Ablation of the Prostate

The billing and coding information in this article is dependent on the
coverage indications, limitations and/or medical necessity described in the
related LCD L38682 Transurethral Waterjet Ablation of the Prostate.

**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.

**Documentation Requirements**

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

The information in this article contains billing, coding, or other guidelines
that complement the Local Coverage Determination (LCD) for MolDX: Prognostic
and Predictive Molecular Classifiers for Bladder Cancer L38684.

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

  * Select the appropriate CPT code
  * Enter 1 unit of service (UOS)
  * Enter the appropriate DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part B claim field/types: 
    * Loop 2400 or SV101-7 for the 5010A1 837P
    * Box 19 for paper claim
  * Enter the appropriate DEX Z-CodeTM identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types: 
    * Line SV202-7 for 837I electronic claim
    * Block 80 for the UB04 claim form
  * Select the appropriate ICD-10-CM code
Billing and Coding: Implantable Continuous Glucose Monitors (I-CGM)

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L38686 Implantable Continuous Glucose Monitors
(I-CGM). Please refer to the LCD for reasonable and necessary requirements.

**Coding Guidance**

**Implantation** of an implantable continuous glucose monitor (I-CGM) that
meets the appropriate criteria as mentioned in LCD L38686 Implantable
Continuous Glucose Monitors (I-CGM) is reported with:

  * **CPT code 0446T** \- Creation of subcutaneous pocket with insertion of implantable interstitial glucose sensor, including system activation and patient training

**Removal** of an I-CGM is reported with:

  * **CPT code 0447T** \- Removal of implantable interstitial glucose sensor from subcutaneous pocket via incision

**Removal with immediate subsequent replacement** of an I-CGM is reported
with:

  * **CPT code 0448T** \- Removal of implantable interstitial glucose sensor with creation of subcutaneous pocket at different anatomic site and insertion of new implantable sensor, including system activation

**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.

**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.