evekhm/cms_iom_500 huggingface dataset:
NCD - Implantable Cardioverter Defibrillators (ICDs) (20.4)
04/2022 - Transmittal 11264, dated February 10, 2022, is being rescinded and replaced by Transmittal 11342, dated, April 6, 2022 to (1) revise BR 12606.10 instructions for NCD 110.24, (2) BR12606.2, fix typo in NCD 160.18 spreadsheet ICD-10 G40.384, which should be G40.834, and, (3) revise implementation verbiage (no changes to the actual implementation date).  All other information remains the same.  (TN 11342) (CR12606)02/2022 - This Change Request (CR) constitutes a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received.(TN 11264) (CR12606)01/2022 - Transmittal 11068, dated October 21, 2021, is being rescinded and replaced by Transmittal 11179, dated, January 12, 2022 to revise the attachment for NCD 110.24, CAR-T, to add business requirement 12480.10.1 by adding generic unspecified procedure codes, to clarify coverage and claims processing in the policy section and to review the implementation date. All other information remains the same. (TN 11179) (CR12480)10/2021 - This Change Request (CR) constitutes a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received. (TN 11068) (CR12480)09/2021 - This Change Request (CR) constitutes a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received. (TN 11025) (CR12399)
NCD - Implantable Cardioverter Defibrillators (ICDs) (20.4)
08/2021 - This Change Request (CR) constitutes a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received. (TN 10963) (CR12399)2/2019 - Transmittal 211, dated December 13, 2018, is being rescinded and replaced by Transmittal 213 dated, February 15, 2019 to change the implementation date from February 26, 2019 to March 26, 2019. All other information remains the same.12/2018 - Transmittal 209, dated November 21, 2018, is being rescinded and replaced by Transmittal 211, dated, December 13, 2018, to add a clarifying note to the policy section of the Business Requirements document that was inadvertently left out. All other information remains the same. (TN 211) (CR10865)11/2018 - This Change Request (CR) and Publication (Pub.) 100-03 Medicare NCD Manual reflects the Agency's final decision dated February 15, 2018, regarding the reconsideration of NCD 20.4, Implantable Cardiac Defibrillators. A subsequent CR will be released at a later date that contains a Pub.100-04 Claims Processing Manual update with accompanying instructions. Until that time, the Medicare Administrative Contractors (MACs) shall be responsible for implementing NCD 20.4.(TN 209) (CR10865)
NCD - Implantable Cardioverter Defibrillators (ICDs) (20.4)
06/2016 - Transmittal 1665, dated May 13, 2016, is being rescinded and replaced by Transmittal 1672 to: (1) 9631.1: Remove FISS responsibility and 1st sentence; (2) 9631.2: Remove additional procedure codes, including 0075T, 0076T; (3) 9631.4: Revise descriptor of dx L59.8; (4) 9631.6: Add deletion of dx C49.10, C65.9, remove deletion of dx C54.9, remove deletion of invalid dx C47.90; (5) 9631.8: Remove deletion of invalid dx C51.29, replace with deletion of dx C50.029; (6) 9631.9: Add deletion of 0V504ZZ, 0V500ZZ, override capability, and contractor discretion verbiage. All other information remains the same. (TN 1672) (CR9631)05/2016 - This change request (CR) is the 7th maintenance update of ICD-10 conversions and other coding updates specific to national coverage determinations (NCDs). The majority of the NCDs included are a result of feedback received from previous ICD-10 NCD CR7818, CR8109, CR8197, CR8691, CR9087, CR9252, and CR9540. Some are the result of revisions required to other NCD-related CRs released separately.   Edits to ICD-10 and other coding updates specific to NCDs will be included in subsequent, quarterly releases as needed. No policy-related changes are included with these updates. Any policy-related changes to NCDs continue to be implemented via the current, long-standing NCD process.  (TN 1665) (CR9631)
NCD - Implantable Cardioverter Defibrillators (ICDs) (20.4)
03/2013 - CMS translated the information for this policy from ICD-9-CM/PCS to ICD-10-CM/PCS according to HIPAA standard medical data code set requirements and updated any necessary and related coding infrastructure. These updates do not expand, restrict, or alter existing coverage policy.  Implementation date: 10/07/2013 Effective date: 10/1/2015. (TN 1199) (TN 1199) (CR 8197)3/2005 - Expanded national coverage by including new indications. Effective and implementation dates 01/27/2005. (TN 29) (CR 3604)08/2003 - Expanded coverage for coronary artery disease with a documented prior myocardial infarction (MI), a measured left ventricular ejection fraction   0.35, and inducible, sustained ventricular tachyarrhythmia or ventricular fibrillation at electrophysiology study; or documented prior MI and a measured left ventricular ejection fraction  0.30 and a QRS duration of >120 milliseconds. All other indications for defibrillators not otherwise specified remain noncovered except when furnished in accordance with FDA-approved protocols governing Category B Investigational Device Exemption; clinical trials as stated in 42 FR Part 405. Effective and implementation dates 10/01/2003. (TN 173) (CR 2880)04/1999 - Expanded coverage for additional types of cardiac patients. Effective and implementation dates 07/01/1999. (TN 115) (CR 825)01/1986 - Provided coverage to treat life-threatening ventricular tachyarrhythmias. Effective date 01/24/1986. (TN 3)
NCD - Implantable Cardioverter Defibrillators (ICDs) (20.4)
OtherNational Coverage Analyses (NCAs)This NCD has been or is currently being reviewed under the National CoverageDetermination process. The following are existing associations with NCAs, from the NationalCoverage Analyses database.Original Consideration for Implantable Cardioverter Defibrillators (ICDs) (CAG-00157N)First reconsideration for Implantable Defibrillators - Clinical Trials (CAG-00157R)Second reconsideration for Implantable Defibrillators (CAG-00157R2)Third reconsideration for Implantable Defibrillators (CAG-00157R3)Fourth reconsideration for Implantable Cardioverter Defibrillators (CAG-00157R4)Coding Analyses for Labs (CALs)This NCD has been or is currently being reviewed under the National CoverageDetermination process. The following are existing associations with CALs, from the Coding Analyses for Labsdatabase.Additional InformationOther VersionsTitleVersionEffective BetweenImplantable Cardioverter Defibrillators (ICDs)507/31/2023 - N/AViewImplantable Cardioverter Defibrillators (ICDs)402/15/2018 - 07/31/2023You are hereImplantable Automatic Defibrillators301/27/2005 - 02/15/2018ViewImplantable Automatic Defibrillators210/01/2003 - 01/27/2005ViewImplantation of Automatic Defibrillators107/01/1999 - 10/01/2003ViewCPT Copyright StatementCPT only copyright 2002-2011 American Medical Association. All rights reserved.CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Apply to Government Use.Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use.The AMA does not directly or indirectly practice medicine or dispense medical services.The AMA assumes no liability for data contained or not contained herein.Reasons for Denial
NCD - Implantable Cardioverter Defibrillators (ICDs) (20.4)
Reasons for DenialNote: This section has not been negotiated by the Negotiated RuleMaking Committee.It includes CMSs interpretation of its longstanding policies and is included for informational purposes.Tests for screening purposes that are performed in the absense of signs, symptoms, complaints, or personal history of disease orinjury are not covered except as explicity authorized by statue.These include exams required by insurance companies, business establishments, government agencies, or other third parties.Tests that are not reasonable and necessary for the diagnosis or treatment of an illness or injury are not covered according to the statue.Failure to provide documentation of the medical necessity of tests may result in denial of claims.The documentation may include notes documenting relevant signs, symptoms, or abnormal findings that substantiate the medical necessity for ordering the tests.In addition, failure to provide independent verification that the test was ordered by the treating physician (or qualified nonphysician practitioner)through documentation in the physicians office may result in denial.A claim for a test for which there is a national coverage or local medical review policy will be denied as not reasonable and necessaryif it is submitted without an ICD-9-CM code or narrative diagnosis listed as covered in the policy unless other medical documentationjustifying the necessity is submitted with the claim.If a national or local policy identifies a frequency expectation, a claim for a test that exceeds that expectation may be denied asnot reasonable and necessary, unless it is submitted with documentation justifying increased frequency.Tests that are not ordered by a treating physician or other qualified treating nonphysician practitioner acting within the scope oftheir license and in compliance with Medicare requirements will be denied as not reasonable and necessary.Failure of the laboratory performing the test to have the appropriate Clinical Laboratory Improvement Act of 1988 (CLIA) certificatefor the testing performed will result in denial of claims.same spacer from search pagecolrowEmail this document to yourself or someone elseAn asterisk (*) indicates arequired field.This email will be sent from you to therecipient email address(es) you enter.Please do not use this feature to contact CMS.To submit a comment or question to CMS, please use the Feedback/Ask a Question link available at the bottomof every MCD page.*Your Name:*Your Name:*Recipient's Email(s):*Recipient's Email(s):Message:Message:Send EmailCancel
NCD - Implantable Cardioverter Defibrillators (ICDs) (20.4)
*Your Name:*Your Name:*Recipient's Email(s):*Recipient's Email(s):Message:Message:Send EmailCancelPage Help forNCD - Implantable Cardioverter Defibrillators (ICDs) (20.4)CloseIntroductionThis page displays your requested National Coverage Determination (NCD).  The document is broken into multiple sections.  You can use the Contents side panel to help navigate the various sections.National Coverage Determinations (NCDs) are national policy granting, limiting or excluding Medicare coverage for a specific medical item or service.More informationNCDs are developed and published by CMS and apply to all states. NCDs are made through an evidence-based process, with opportunities for public participation. Medicare coverage is limited to items and services that are considered "reasonable and necessary" for the diagnosis or treatment of an illness or injury (and within the scope of a Medicare benefit category). An NCD sets forth the extent to which Medicare will cover specific services, procedures, or technologies on a national basis. Medicare Administrative Contractors (MACs) are required to follow NCDs.Printing a Document to PDFThere are multiple ways to create a PDF of a document that you are currently viewing. You can use your browser's Print function (Ctrl-P on a PC or Command-P on a Mac) to view a print preview and then select PDF as the output. Another option is to use the Download button at the top right of the document view pages (for certain document types).Submit Feedback/Ask a Questioncontainer-fluidGet email updatesSign up to get the latest information about your choice of CMS topics in your inbox. Also, you can decide how often you want to get updates.SIGN UPopens in new windowCMS & HHS WEBSITESMedicare.govopens in new windowMedicaid.govopens in new windowInsureKidsNow.govopens in new windowHealthCare.govopens in new windowHHS.govopens in new windowHELPFUL LINKSAcronymsArchiveContactsGlossaryPrivacy policyRSS FEEDSNewsroomBlogPodcastopens in new windowopens in new windowA federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services.7500 Security Boulevard, Baltimore, MD 21244opens in new windowopens in new windowopens in new windowTOOLSWeb policiesopens in new windowPlain languageopens in new window
NCD - Implantable Cardioverter Defibrillators (ICDs) (20.4)
opens in new windowopens in new windowopens in new windowTOOLSWeb policiesopens in new windowPlain languageopens in new windowNo Fear Actopens in new windowFreedom of Information Actopens in new windowInspector Generalopens in new windowFrequently Asked Questions (FAQs)Many questions can be answered on theHelp & Resources pagein the How To Library or by viewing the FAQs below. Please take a look and if you still have questions or would like to leave feedback,contact us!Are you a provider and have a question about billing or coding?Please contact your Medicare Administrative Contractor (MAC). MACs can be found in theMAC Contacts Report.Do you have questions related to the content of a specific Local Coverage Determination (LCD) or an Article?Please contact the Medicare Administrative Contractor (MAC) who owns the document.  The contractor information can be found at the top of the document in theContractor Information section(expand the section to see the details). MACs can also be can be found in theMAC Contacts Report.Are you a beneficiary and have questions about your coverage?Please call 1-800-Medicare or visitMedicare.govAre you looking for codes? (e.g., CPT/HCPCS, ICD-10)
NCD - Implantable Cardioverter Defibrillators (ICDs) (20.4)
Are you a beneficiary and have questions about your coverage?Please call 1-800-Medicare or visitMedicare.govAre you looking for codes? (e.g., CPT/HCPCS, ICD-10)Local CoverageFor the most part, codes are no longer included in the LCD (policy). You will find them in the Billing & Coding Articles. Try using theMCD Searchto find what you're looking for. Enter the code you're looking for in the "Enter keyword, code, or document ID" box.  The list of results will include documents which contain the code you entered.Please Note:For Durable Medical Equipment (DME) MACs only, CPT/HCPCS codes remain located in LCDs. All other Codes (ICD-10, Bill Type, and Revenue) have moved to Articles for DME MACs, as they have for the other Local Coverage MAC types.National CoverageNCDs do not contain claims processing information like diagnosis or procedure codes nor do they give instructions to the provider on how to bill Medicare for the service or item. For this supplementary claims processing information we rely on other CMS publications, namely Change Requests (CR) Transmittals and inclusions in the Medicare Fee-For-Service Claims Processing Manual (CPM).In order for CMS to change billing and claims processing systems to accommodate the coverage conditions within the NCD, we instruct contractors and system maintainers to modify the claims processing systems at the national or local level through CR Transmittals. CRs are not policy, rather CRs are used to relay instructions regarding the edits of the various claims processing systems in very descriptive, technical language usually employing the codes or code combinations likely to be encountered with claims subject to the policy in question. As clinical or administrative codes change or system or policy requirements dictate, CR instructions are updated to ensure the systems are applying the most appropriate claims processing instructions applicable to the policy.How do I find out if a specific CPT code is covered in my state?
NCD - Implantable Cardioverter Defibrillators (ICDs) (20.4)
How do I find out if a specific CPT code is covered in my state?Enter the CPT/HCPCS code in theMCD Searchand select your state from the drop down. (You may have to accept the AMA License Agreement.) Look for a Billing and Coding Article in the results and open it. (Or, for DME MACs only, look for an LCD.)  Review the article, in particular the Coding Information section.If you need more information on coverage, contact the Medicare Administrative Contractor (MAC) who published the document.  The contractor information can be found at the top of the document in theContractor Information section(expand the section to see the details).If you dont find the Article you are looking for,contact your MAC.Did you receive a Medicare coverage denial?Was your Medicare claim denied?  Here are some hints to help you find more information:1) Check out the Beneficiary card on theMCD Searchpage.2) Try using theMCD Searchand enter your information in the "Enter keyword, code, or document ID" box.  Your information could include a keyword or topic you're interested in; a Local Coverage Determination (LCD) policy or Article ID; or a CPT/HCPCS procedure/billing code or an ICD-10-CM diagnosis code.  Try entering any of this type of information provided in your denial letter.3) Contact yourMAC.4) VisitMedicare.govor call 1-800-Medicare.It is Thursday and the weekly MCD data isnt refreshed?Please use the Reset Search Data function, found in the top menu under the Settings (gear) icon. If that doesnt work please contacttechnical support.Are you having technical issues with the Medicare Coverage Database (MCD)?Technical issues include things such as a link is broken, a report fails to run, a page is not displaying correctly, a search is taking an unexpectedly long time to complete. If you are having an issue like this please contacttechnical support.Submit Feedback/Ask a QuestionCancelMCD Session Expiration WarningYour MCD session is currently set to expire in 5 minutes due to inactivity. If your session expires, you will lose all items in your basket and any active searches. If you would like to extend your session, you may select theContinueButton.ContinueCancelReset MCD Search Data
NCD - Implantable Cardioverter Defibrillators (ICDs) (20.4)
ContinueCancelReset MCD Search DataIf you are experiencing any technical issues related to the search, selecting the 'OK' button to reset the search data should resolve your issues.OKCancelNoticeYou are leaving the CMS MCD and are being redirected to the CMS MCD Archive that contains outdated (No Longer In Effect) Local Coverage Determinations and ArticlesContinueCancelNoticeYou are leaving the CMS MCD and are being redirected toContinueCancelPopper is used with permission under the MIT license: https://github.com/popperjs/popper-core/blob/master/LICENSE.md
Article - Billing and Coding: MolDX: Inivata™, InVisionFirst®, Liquid Biopsy for Patients with Lung Cancer (A56333)
CMS National Coverage PolicyTitle XVIII of the Social Security Act, 1833(e) Prohibits Medicare payment for any claim which lacks the necessary information to process the claim.CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, 80.1.2 A/B MAC (B) Contacts with Independent Clinical LaboratoriesCMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Ch. 16, 50.5 Jurisdiction of Laboratory Claims, 60.1.1 Independent Laboratory Specimen Drawing, 60.2 Travel Allowance.CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 23, 10 Reporting ICD Diagnosis and Procedure CodesArticle TextThe information in this article contains billing, coding, or other guidelines that complement the Local Coverage Determination (LCD) for MolDX: Inivata, InVisionFirst, Liquid Biopsy for Patients with Lung Cancer L37921.To report an InvisionFirst  Lung service, please submit the following claim information:Select CPT code 81479Enter 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 837PBox 19 for paper claimEnter 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 claimBlock 80 for the UB04 claim formSelect the appropriate ICD-10-CM code
Article - Billing and Coding: MolDX: Breast Cancer Index® (BCI) Gene Expression Test (A56335)
CMS National Coverage PolicyTitle XVIII of the Social Security Act (SSA) 1833(e), prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.CMS Manual System, Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 80.0 Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests.CMS Internet-Only Manuals, Publication 100-04, Medicare Claims Processing Manual, Chapter 16, 50.5 Jurisdiction of Laboratory Claims, 60.12 Independent Laboratory Specimen Drawing, 60.2. Travel Allowance.CMS Internet Online Manual Pub. 100-04, Medicare Claims Processing Manual, Chapter 23 (Section 10) "Reporting ICD Diagnosis and Procedure Codes".Article TextThe information in this article contains billing, coding, or other guidelines that complement the Local Coverage Determination (LCD) for MolDX: Breast Cancer Index (BCI) Gene Expression Test L37913.Effective 1/01/2019, MolDX will provide limited coverage for the BCI gene expression test.The BCI test is covered for postmenopausal women with invasive breast cancer when the following criteria are met:Pathology reveals invasive carcinoma of the breast that is ER+ and/or PR+ and HER2 -; andPatient has early-stage disease (T1-3, pN0-N1, M0); andPatient has no evidence of distant breast cancer metastasis (i.e., non-relapsed); andTest results will be used in determining treatment management of the patient for chemotherapy and/or endocrine therapy.MolDX expects this test will be performed once per patient lifetime on FFPE tissue from the primary tumor specimen obtained prior to adjuvant treatment.To bill a BCI service, please provide the following claim information:Select CPT code 81518Enter 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 837PBox 19 for paper claimEnter the appropriate DEX Z-Code identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types:
Article - Billing and Coding: MolDX: Breast Cancer Index® (BCI) Gene Expression Test (A56335)
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 claimBlock 80 for the UB04 claim formSelect the appropriate ICD-10-CM code