(Medicare National Coverage Determinations Manual)

Medicare National Coverage Determinations    Manual  Chapter 1, Part 4 (Sections 200  310.1)  Coverage Determinations   Table of Contents  (Rev. 12364, 11- 16-23)  Transmittals for Chapter 1, Part 4   200 -  Pharmacology  200.1 -  Nesiritide for Treatment of Heart Failure Patients (Effective March 2, 2006)  200.2 -  Nebulized Beta Adrenergic Agonist Therapy for Lung Diseases -  (Effective September 10, 2007)  200.3 -  Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimers Disease (AD)  210 -  Prevention  210.1 -  Prostate Cancer Screening Tests  210.2 -  Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer  210.2.1 Screening for Cervical Cancer with Human Papillomavirus (HPV) Testing (Effective July 9, 2015)  210.3  Colorectal Cancer Screening Tests  210.4  Smoking and Tobacco- Use Cessation Counseling (Effective March 22, 2005)  (RETIRED)  210.4.1  Counseling to Prevent Tobacco Use (Effective August 25, 2010)  210.5 -  Diabetes Screening Tests (Effective January 1, 2005)  210.6 -  Screening for Hepatitis B Virus (HBV)  Infection  210.7  Screening for  Human Immunodeficiency Virus (HIV)  210.8  Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse  (Effective October 14, 2011)  210.9  Screening for Depression in Adults (Effective October 14, 2011)  210.10 -  Screening for Sexually Transmitted Infections (STIs) and High Intensity Behavioral Counseling (HIBC) to Prevent STIs  210.11 -  Intensive Behavioral Therapy for Cardiovascular Disease  210.12  Intensive Behavioral Therapy for Obesity 210.13 -  Screening for Hepatitis C Virus (HCV) in Adults  210.14  Lung Cancer Screening with Low Dose Computed Tomography (LDCT)  220 -  Radiology 220.1 -  Computed Tomography (CT)  220.2 -  Magnetic Resonance Imaging  (MRI) (Various Effective Dates Below)  220.2.1 -  Magnetic Resonance Spectroscopy  (RETIRED)  220.3 -  Magnetic Resonance Angiography (RETIRED)  220.4 -  Mammograms  220.5 -  Ultrasound Diagnostic Procedures (Effective May 22, 2007)  220.6  Positron Emission Tomography (PET) Scans   (Effective April 6, 2009)  (RETIRED)  220.6.1  PET for Perfusion of the Heart  (Various Effective Dates)   220.6.2  FDG PET for Lung Cance r (RETIRED)  220.6.3  FDG PET for Esophageal Cancer  (RETIRED)  220.6.4  FDG PET for Colorectal Cancer  (RETIRED)  220.6.5  FDG PET for Lymphoma  (RETIRED)  220.6.6  FDG PET for Melanoma (RETIRED)  220.6.7  FDG PET for Head and Neck Cancers  (RETIRED)  220.6.8  FDG PET for Myocardial Viability  220.6.9  FDG PET for Refractory Seizures  220.6.10  FDG PET for Breast Cancer  (RETIRED)  220.6.11  FDG PET for Thyroid Cancer  (RETIRED)  220.6.12  FDG PET for Soft Tissue Sarcoma  (RETIRED)  220.6.13  FDG Positron Emission Tomography (PET) for Dementia and Neurodegenerative Diseases (Effective September 15, 2004)  220.6.14  FDG PET for Brain, Cervical, Ovarian, Pancreatic, Small Cell Lung, and Testicular Cancers  (RETIRED)  220.6.15  FDG PET for All Other Cancer Indications Not Previously Specified (RETIRED)  220.6.16 -  FDG PET for Infection and Inflammation (Effective March 19, 2008)  (RETIRED)  220.6.17 -  Positron Emission Tomography (PET) (FDG) for Oncologic Conditions -  (Effective June 11, 2013)  220.6.19 -  Positron Emission Tomography NaF -18 (NaF -18 PET) to Identify Bone Metastasis of Cancer (Effective February 26, 2010)  220.6.20 -  Beta Amyloid Positron Emission Tomography (PET)  in Dementia and Neurodegenerative Disease (RETIRED)  220.7 -  Xenon Scan  (RETIRED)  220.8 -  Nuclear Radiology Procedure  (RETIRED)  220.9 -  Digital Subtraction Angiography (DSA)  220.10 -  Portable Hand -Held X -Ray Instrument  220.11 -  Thermography  220.12 -  Single Photon Emission Computed Tomograph (SPECT)  220.13 -  Percutaneous Image- Guided Breast Biopsy 230 -  Renal and Genitourinary System -  ESRD Services  230.1 -  Treatment of Kidney Stones  230.2 -  Uroflowmetric Evaluations  230.3 -  Sterilization  230.4 -  Diagnosis and Treatment of Impotence  230.5 -  Gravlee Jet Washer  230.6 -  Vabra Aspirator  230.7 -  Water Purification and Softening Systems Used in Conjunction With Home Dialysis  230.8 -  Non -Implantable Pelvic Floor  Electrical Stimulator  230.9 -  Cryosurgery of Prostate  230.10 -  Incontinence Control Devices  230.11 -  Diagnostic Pap Smears  (RETIRED)  230.12 -  Dimethyl Sulfoxide (DMSO)  230.13 -  Peridex CAPD Filter Set  230.14 -  Ultrafiltration Monitor  230.15 -  Electrical Continence Aid  230.16 -  Bladder Stimulators (Pacemakers)  230.17 -  Urinary Drainage Bags  230.18 -  Sacral Nerve Stimulation for Urinary Incontinence  230.19 -  Levocarnitine for Use in the Treatment of Carnitine Deficiency in ESRD Patients  240 -  Respiratory System  240.1 -  Lung Volume Reduction Surgery (Reduction Pneumoplasty) (Various Effective Dates Below)  240.2 -  Home Use of Oxygen  240.2.1 -  Home Use of Oxygen in Approved Clinical Trials (Effective March 20, 2006)  240.2.2  Home Oxygen Use to Treat Cluster Headache (CH) (Effective January 4, 2011)  (RETIRED)  240.3 -  Heat Treatment, Including the Use of Diathermy and Ultra -Sound for Pulmonary Conditions  240.4 -  Continuous Positive Airway Pressure (CPAP) Therapy for Obstructive Sleep Apnea (OSA) (Effective March 13, 2008)  240.4.1 -  Sleep Testing for Obstructive Sleep Apnea (OSA) (Effective March 3, 2009)  240.5 -  Intrapulmonary Percussive Ventilator (IPV)  240.6 -  Transvenous (Catheter) Pulmonary Embolectomy (RETIRED)  240.7 -  Postural Drainage Procedures and Pulmonary Exercises  240.8 -  Pulmonary Rehabilitation Services  250 -  Skin 250.1 -  Treatment of Psoriasis  250.2 -  Hemorheograph  250.3 -  Intravenous Immune Globulin for the Treatment of Autoimmune Mucocutaneous Blistering Diseases  250.4 -  Treatment of Actinic Keratosis  250.5 -  Dermal Injections for the Treatment of Facila Lipodystrophy Syndrome (LDS)  260 -  Transplantation -  Solid Organ Transplants  260.1 -  Adult Liver Transplantation  260.2 -  Pediatric Liver Transplantation  260.3 -  Pancreas Transplants (Effective April 26, 2006)  260.3.1  Islet Cell Transplantation in the Context of a Clinical Trial  260.4 -  Reserved  260.5 -  Intestinal and Multi- Visceral Transplantation (Effective May 11, 2006)  260.6 -  Dental Examination Prior to Kidney Transplantation 260.7 -  Lymphocyte Immune Globulin, Anti -Thymocyte Globulin (Equine)  260.8 -  Reserved  260.9 -  Heart Transplants  260.10 -  Heartsbreath Test for Heart Transplant Rejection (Effective December 8, 2008)  270 -  Wound Treatment  270.1 -  Electrical Stimulation (ES) and Electromagnetic Therapy for the Treatment of Wounds  (Effective July 1, 2004)  270.2 -  Noncontact Normothermic Wound Therapy (NNWT)  270.3 -  Blood- Derived Products for Chronic Non- Healing Wounds  (Various Effective Dates Below)  270.4 -  Treatment of Decubitus Ulcers  270.5 -  Porcine Skin and Gradient Pressure Dressings  270.6 -  Infrared Therapy Devices (Effective October 24, 2006)  280 -  Medical and Surgical Supplies  280.1 -  Durable Medical Equipment Reference List (Effective May 5, 2005)  280.2 -  White Cane for Use by a Blind Person  280.3 -  Mobility Assistive Equipment (MAE) (Effective May 5, 2005)  280.4 -  Seat Lift  280.6 -  Pneumatic Compression Devices  280.7 -  Hospital Beds  280.8 -  Air-Fluidized Bed 280.10 -  Prosthetic Shoe  280.11 -  Corset Used as Hernia Support  280.12 -  Sykes Hernia Control  280.13 -  Transcutaneous Electrical Nerve Stimulators (TENS)  (RETIRED)  280.14  Infusion Pumps  280.15 -  INDEPENDENCE iBOT 4000 Mobility System (Effective July 27, 2006)  280.16 Seat Elevation Equipment (Power Operated) on Power Wheelchairs               (Effective May 16, 2023)  290 -  Nursing Services  290.1 -  Home Health Visits to a Blind Diabetic  290.2 -  Home Health Nurses Visits to Patients Requiring Heparin Injections  300 -  Diagnostic Tests Not Otherwise Classified  300.1 -  Obsolete or Unreliable Diagnostic Tests  310 -  Clinical Trials  310.1 -  Routine Costs in Clinical Trials  (Effective July 9, 2007)   200 - Pharmacology (Rev. 1, 10- 03-03)  No coverage determinations   200.1 - Nesiritide for Treatment of Heart Failure Patients (Effective March 2, 2006)  (Rev. 173, Issued: 09- 04-14, Effective: Upon Implementation: of ICD -10, Implementation: Upon Implementation of ICD -10)  A. General  Nesiritide (Natrecor) is Food and Drug Administration (FDA) -approved for the intravenous treatment of patients with acutely decompensated congestive heart failure (CHF) who have dyspnea (shortness of breath) at rest or with minimal activity.  Nesiritide is not self -administered.   B. Nationally Covered Indications   N/A  C. Nationally Non -Covered Indications   Effective for dates of service on or after March 2, 2006, the Centers for Medicare & Medicaid Services has determined that there is sufficient evidence to conclude that the use of Nesiritide for the treatment of CHF is not reasonable and necessary for Medi care beneficiaries in any setting.   D. Other   Effective for dates of service on or after March 2, 2006, this determination applies only to the treatment of CHF and does not change Medicare Administrative Contractor (MAC) discretion to cover other off -label uses of Nesiritide or use consistent with the  current FDA indication for intravenous treatment of patients with acutely decompensated CHF who have dyspnea at rest or with minimal activity.   200.2 - Nebulized Beta Adrenergic Agonist Therapy for Lung Diseases  (Effective September 10, 2007)  (Rev. 173, Issued: 09- 04-14, Effective: Upon Implementation: of ICD -10, Implementation: Upon Implementation of ICD -10)  A. General