(Medicare Claims Processing Manual)

o The applicable ICD -10-CM codes are in the table below:   ICD-10-CM Codes  A18.84  I11.0  I11.9  I13.0  I13.10  I13.11  I13.2  I20.0  I21.01  I21.02  I21.09  I21.11  I21.19  I21.21  I21.29  I21.3  I21.4  I22.1  I22.2  I22.8  I23.0  I23.1  I23.2  I23.3  I23.4  I23.5  I23.6  I23.7  I23.8  I25.10  I25.110  I25.700  I25.710  I25.720  I25.730  I25.750  I25.760  I25.790  I26.01  I26.02  I26.09  I27.0  I27.1  I27.2  I27.81  I27.89  I27.9  I30.0  I30.1  I30.8  I30.9  I32 I38 I39 I46.2  I46.8  I46.9  I47.0  I471 I472 I47.9  I48.0  I48.1  I48.1  I48.2  I48.3  I48.4  I48.91  I48.92  I49.01  I49.02  I49.1  I49.2  I49.3  I49.40  I49.49  I49.5  I49.8  I49.9  I50.1  I50.20  I50.21  I50.22  I50.23  I50.30  I50.31  I50.32  I50.33  I50.40  I50.41  I50.42  I50.43  I50.9  I51 I51.0  I51.1  I51.2  I51.3  I51.4  I51.5  I51.7  I51.89  I51.9  I52 I97.0  I97.110  I97.111  I97.120  I97.121  I97.130  I97.131  I97.190  I97.191  M32.11  M32.12  R00.1  R57.0  R57.8  R57.9   o Generalized severe debilitation.  The applicable ICD -9-CM codes are:  203.00, 203.01, all codes for diabetes mellitus, 518.81, 585, 586, 799.3, 799.4, and V46.1.  The applicable ICD-10-CM codes are:  J96.850, J96.00 through J96.02, J96.90 through J96.91, N18.1 through N19, R53.81, R64, and Z99.11 through Z99.12.  Or   o Sickle Cell disease.  The applicable ICD -9-CM codes are 282.4, 282.60, 282.61, 282.62, 282.63, and 282.69.  The applicable ICD -10-CM codes are D56.0 through D56.3, D56.5 through D56.9, D57.00 through D57.1, D57.20, D57.411 through D57.419, and D57.811 through D57.819.  40 - Magnetic Resonance Imaging (MRI) Procedures  (Rev. 2307, Issued: 09- 22-11, Effective: 07 -07-11/02- 24-11(CR 7296), Implementation: 09- 26-11)  Effective September 28, 2009   The Centers for Medicare & Medicaid Services (CMS) finds that the non -coverage of magnetic resonance imaging (MRI) for blood flow determination is no longer supported by the available evidence.  CMS is removing the phrase blood flow measurement and local Medicare contractors will have the discretion to cover (or not cover).   Consult Publication (Pub.) 100- 03, National Coverage Determinations (NCD) Manual , chapter 1, s ection 220.2, for specific coverage and non- coverage indications associated with MRI and MRA (Magnetic Resonance Angiography).   Prior to January 1, 2007  A/B MACs (B) do not make additional payments for three or more MRI sequences.  The relative value units (RVUs) reflect payment levels for two sequences.   The technical component (TC) RVUs for MRI procedures that specify with contrast include payment for paramagnetic contrast media.  A/B MACs (B) do not make separate payment under code A4647.   A diagnostic technique has been developed under which an MRI of the brain or spine is first performed without contrast material, then another MRI is performed with a standard (0.1mmol/kg) dose of contrast material and, based on the need to achieve a better  image, a third MRI is performed with an additional double dosage (0.2mmol/kg) of contrast material.  When the high- dose contrast technique is utilized, A/B MACs (B):    Do not pay separately for the contrast material used in the second MRI procedure;    Pay for the contrast material given for the third MRI procedure through supply code Q9952, the replacement code for A4643, when billed with Current Procedural Terminology (CPT) codes 70553, 72156, 72157, and 72158;    Do not pay for the third MRI procedure.  For example, in the case of an MRI of the brain, if CPT code 70553 (without contrast material, followed by with contrast material(s) and further sequences) is billed, make no payment for CPT code 70551 (without cont rast material(s)), the additional procedure given for the purpose of administering the double dosage, furnished during the same session.  Medicare does not pay for the third procedure (as distinguished from the contrast material) because the CPT definition  of code 70553 includes all further sequences; and    Do not apply the payment criteria for low osmolar contrast media in 30.1.2 to billings for code Q9952, the replacement code for A4643.   Effective January 1, 2007  With the implementation for calendar year 2007 of a bottom -up methodology, which utilizes the direct inputs to determine the practice expense (PE) relative value units (RVUs), the cost of the contrast media is not included in the PE RVUs.  Therefore, a separate payment for the contrast media used in various imaging procedures is paid.  In addition to the CPT code representing the imaging procedure, separately bill the appropriate HCPCS Q code (Q9945  Q9954; Q9958- Q9964) for the contrast medium utilized in performing the service.  Effective February 24, 2011  Medicare will allow for coverage of MRI for beneficiaries with implanted PMs or cardioverter defibrillators (ICDs) for use in an MRI environment in a Medicare -approved clinical study as described in section 220.C.1 of the NCD manual.   Effective July 7, 2011  Medicare will allow for coverage of MRI for beneficiaries with implanted pacemakers (PMs) when the PMs are used according to the Food and Drug Administration (FDA) -approved labeling for use in an MRI environment as described in section 220.2.C.1 of the NCD  Manual.   40.1  Magnetic Resonance Angiography (MRA)  (Rev. 2171, Issued: 03- 04-11, Effective: 02 -24-11, Implementation: 04 -04-11)  40.1.1  Magnetic Resonance Angiography (MRA) Coverage Summary  (Rev. 2171, Issued: 03 -04-11, Effective: 02 -24-11, Implementation: 04 -04-11)  Section 1861(s)(2)(C) of the Social Security Act provides for coverage of diagnostic testing. Coverage of magnetic resonance angiography (MRA) of the head and neck, and MRA of the peripheral vessels of the lower extremities is limited as described in Publication (Pub.) 100 -03, the Medicare National Coverage Determinations (NCD) Manual. This instruction has been revised as of July 1, 2003, based on a determination that coverage is reasonable and necessary in additional circumstances. Under that instruction, MRA is generally cove red only to the extent that it is used as a substitute for contrast angiography, except to the extent that there are documented circumstances consistent with that instruction that demonstrates the medical necessity of both tests.  Prior to June 3, 2010, there was no coverage of MRA outside of the indications and circumstances described in that instruction.  Effective for claims with dates of service on or after June 3, 2010, contractors have the discretion to cover or not cover all indications of MRA (and magnetic resonance imaging (MRI)) that are not specifically nationally covered or nationally non- covered as stated in section 220.2 of the NCD Manual.  Because the status codes for HCPCS codes 71555, 71555- TC, 71555- 26, 74185, 74185- TC, and 74185-26 were changed in the Medicare Physician Fee Schedule Database from N to R on April 1, 1998, any MRA claims with those HCPCS codes with dates of service bet ween April 1, 1998, and June 30, 1999, are to be processed according to the contractors discretionary authority to determine payment in the absence of national policy.  Effective for claims with dates of service on or after February 24, 201l, Medicare will provide coverage for MRIs for beneficiaries with implanted cardiac pacemakers or implantable cardioverter defibrillators if the beneficiary is enrolled in an approved c linical study under the Coverage with Study Participation form of Coverage with Evidence Development that meets specific criteria per Pub. 100- 03, the NCD Manual, chapter 1, section 220.2.C.1.  40.1.2 - HCPCS Coding Requirements  (Rev. 1472, Issued: 03- 06-08, Effective: 05 -23-07, Implementation: 04- 07-08)  Providers must report HCPCS codes when submitting claims for MRA of the chest, abdomen, head, neck or peripheral vessels of lower extremities. The following HCPCS codes should be used to report these services:   MRA  Code  MRA of head  70544, 70544- 26, 70544- TC MRA of head  70545, 70545- 26, 70545- TC MRA of head  70546, 70546- 26, 70546- TC MRA of neck  70547, 70547- 26, 70547- TC MRA of neck  70548, 70548- 26, 70548- TC MRA of neck  70549, 70549- 26, 70549- TC MRA of chest  71555, 71555- 26, 71555- TC MRA of pelvis  72198, 72198- 26, 72198- TC MRA of abdomen (dates of service on or after July 1, 2003)  see below.  74185, 74185- 26, 74185- TC MRA of peripheral vessels of lower extremities  73725, 73725- 26, 73725- TC  Hospitals subject to OPPS should report the following C codes in place of the above HCPCS codes as follows:    MRA of chest 71555: C8909  C8911  MRA of abdomen 74185: C8900  C8902   MRA of peripheral vessels of lower extremities 73725: C8912  C8914   For claims with dates of service on or after July 1, 2003, coverage under this benefit has been expanded for the use of MRA for diagnosing pathology in the renal or aortoiliac arteries. The following HCPCS code should be used to report this expanded coverage of MRA:    MRA, pelvis, with or without contrast material(s) 72198, 72198- 26, 72198- TC  Hospitals subject to OPPS report the following C codes in place of HCPCS code 72198:    MRA, pelvis, with or without contrast material(s) 72198: C8918 -  C8920  NOTE:   Information regarding the claim form locator that corresponds to the HCPCS code and a table to crosswalk its CMS -1450 form locator to the 837 transaction is found in Chapter 25.