evekhm/cms_iom_500 huggingface dataset:
(Medicare National Coverage Determinations Manual)
Photosensitive drugs are the light -sensitive agents used in photodynamic therapy. Once introduced into the body, these drugs selectively identify and adhere to diseased tissue. The drugs remain inactive u ntil they are exposed to a specific wavelength of light, by means of a laser, that corresponds to their absorption peak. The activation of a photosensitive drug results in a photochemical reaction which treats the diseased tissue without affecting surrounding normal tissue.  Verteporfin   Verteporfin, a benzoporphyrin derivative, is an intravenous lipophilic photosensitive drug with an absorption peak of 690 nm. This drug was first approved by the Food and Drug Administration on April 12, 2000, and subseque ntly, approved for inclusion in the United States Pharmacopoeia on July 18, 2000, meeting Medicares definition of a drug when used in conjunction with ocular photodynamic therapy (OPT) (see section 80.2, Photodynamic Therapy) when furnished intravenousl y incident to a physicians service. For patients with age- related macular degeneration (AMD), verteporfin is only covered with a diagnosis of neovascular AMD with predominately classic subfoveal choroidal neovascular (CNV) lesions (where the area of class ic CNV occupies 50% of the area of the entire lesion) at the initial visit as determined by a fluorescein angiogram (FA). Subsequent follow -up visits will require either an optical coherence tomography or an FA to access treatment response. OPT with verteporfin is covered for the above indication and will remain non- covered for all other indications related to AMD (see section 80.2). OPT with verteporfin for use in non -AMD conditions is eligible for coverage through individual A/B MAC discretion.  80.3.1 - Verteporfin - Effective April 3, 2013  (Rev. 173, Issued: 09- 04-14, Effective: Upon Implementation: of ICD -10, Implementation: Upon Implementation of ICD -10)  A. General
(Medicare National Coverage Determinations Manual)
A. General   Verteporfin, a benzoporphyrin derivative, is an intravenous lipophilic photos ensitive drug with an absorption peak of 690 nm. Verteporfin was first approved by the Food and Drug Administration on April 12, 2000, and subsequently approved for inclusion in the United States Pharmacopoeia on July 18, 2000, meeting Medicares definition of a drug as defined under 1861(t)(1) of the Social Security Act. Verteporfin is only covered when used in conjunction with ocular photodynamic therapy (OPT) when furnished intravenously incident to a physicians service.   B. Nationally Covered Indicat ions  Effective April 1, 2004, OPT with verteporfin is covered for patients with a diagnosis of neovascular age -related macular degeneration (AMD) with:    Predominately classic subfoveal  choroidal neovascularization (CNV) lesions (where the area of classic CNV occupies 50% of the area of the entire lesion) at the initial visit as determined by a fluorescein angiogram (FA). (CNV lesions are comprised of classic and/or occult components.) Subsequent follow -up visits require either an optical coherence tomography (effective April 3, 2013) or an FA (effective April 1, 2004) to access treatment response.   There are no requirements regarding visual acuity, lesion size, and number of retreatmen ts when treating predominantly classic lesions.    Subfoveal occult with no classic CNV associated with AMD.    Subfoveal minimally classic CNV (where the area of classic CNV occupies <50% of the area of the entire lesion) associated with AMD.   The above 2 indications are considered reasonable and necessary only when:   1. The lesions are small (4 disk areas or less in size) at the time of initial treatment or within the 3 months prior to initial treatment; and,   2.  The lesions have shown evidence of progres sion within the 3 months prior to initial treatment. Evidence of progression must be documented by deterioration of visual acuity (at least 5 letters on a standard eye examination chart), lesion growth (an increase in at least 1 disk area), or the appearan ce of blood associated with the lesion.   C. Nationally Non -Covered Indications
(Medicare National Coverage Determinations Manual)
C. Nationally Non -Covered Indications   Other uses of OPT with verteporfin to treat AMD not already addressed by the Centers for Medicare & Medicaid Services will continue to be non- covered. These include, but are n ot limited to, the following AMD indications: juxtafoveal or extrafoveal CNV lesions (lesions outside the fovea), inability to obtain an FA, or atrophic or dry AMD.   D. Other  The OPT with verteporfin for other ocular indications, such as pathologic myopia or presumed ocular histoplasmosis syndrome, continue to be eligible for local coverage determinations through individual A/B MAC discretion.  80.4 - Hydrophilic Contact Lenses  (Rev. 173, Issued: 09- 04-14, Effective: Upon Implementation: o f ICD -10, Implementation: Upon Implementation of ICD -10)  Hydrophilic contact lenses are eyeglasses within the meaning of the exclusion in 1862(a)(7)  of the Social Security Act and are not covered when used in the treatment of non-diseased eyes with spherical ametrophia, refractive astigmatism, and/or corneal astigmatism.  Payment may be made under the prosthetic device benefit, however, for hydrophili c contact lenses when prescribed for an aphakic patient.   A/B MACs are authorized to accept a Food and Drug Administration (FDA ) letter of approval or other FDA -published material as evidence of FDA approval.  (See 80.1 for coverage of a hydrophilic lens as a corneal bandage.)   Cross -references:   The Medicare Benefit Policy Manual, Chapter 15, Covered Medical and Other Health Services, 100 and 120.  The Medicare Benefit Policy Man ual, Chapter 16, General Exclusions from Coverage, 20 and 90.  80.5 - Scleral Shell  (Rev. 1, 10- 03-03) CIM 65.3
(Medicare National Coverage Determinations Manual)
Scleral shell (or shield) is a catchall term for different types of hard scleral contact lenses.  A scleral shell fits over the entire expo sed surface of the eye as opposed to a corneal contact lens which covers only the central non- white area encompassing the pupil and iris.  Where an eye has been rendered sightless and shrunken by inflammatory disease, a scleral shell may, among other things, obviate the need for surgical enucleation and prosthetic implant and act to support the surrounding orbital tissue.  In such a case, the device serves essentially as an artificial eye.  In this situation, payment may be made for a scleral shell under 1861(s)(8)  of the Act.   Scleral shells are occasionally used in combination with artificial tears in the treatment of dry eye of diverse etiology.  Tears ordinarily dry at a rapid rate, and are continually replaced by the lacrimal gland.  When the lacrimal gland fails, the half -life of artificial tears may be greatly prolonged by the use of the scleral contact lens as a protective barrier against the drying action of the atmosphere.  Thus, the difficult and sometimes hazardous process of frequent installation of artificial tears may be avoided.  The lens acts in this instance to substitute, in part, for the functioning of the diseased lacrimal gland and would be covered as  a prosthetic device in the rare case when it is used in the treatment of dry eye.   Cross -references:   The Medicare Benefit Policy Manual, Chapter 15, Covered Medical and Other Health Services, 120 and 130  The Medicare Benefit Policy Manual, Chapter 1, Inpatient Hospital Services, 40 and 120.1.  80.6 - Intraocular Photography  (Rev. 1, 10- 03-03) CIM 35 -39  Intraocular photography is covered when used for the diagnosis of such conditions as macular degeneration, retinal neoplasms, choroid di sturbances and diabetic retinopathy, or to identify glaucoma, multiple sclerosis and other central nervous system abnormalities.  Make Medicare payment for the use of this procedure by an opthalmologist in these situations when it is reasonable and necessa ry for the individual patient to receive these services.
(Medicare National Coverage Determinations Manual)
80.7 - Refractive Keratoplasty  (Rev. 1, 10- 03-03) CIM 35 -54  Not Covered   Refractive keratoplasty is surgery to reshape the cornea of the eye to correct vision problems such as myopia (nearsightedness) and hyperopia (farsightedness).  Refractive keratoplasty procedures include keratomileusis, in which the front of the cornea is removed, frozen, reshaped, and stitched back on the eye to correct either near or farsightedness; keratophakia, in which a reshaped donor cornea is inserted in the eye to correct farsightedness; and radial keratotomy, in which spoke -like slits are cut in the cornea to weaken and flatten the normally curved central portion to correct nearsightedness.   The correction of common refractive errors by eyeglasses, contact lenses or other prosthetic devices is specifically excluded from coverage.  The use of radial  keratotomy and/or keratoplasty for the purpose of refractive error compensation is considered a substitute or alternative to eye glasses or contact lenses which are specifically excluded by 1862 (a)(7)  of the Act (except in certain cases in connection with cataract surgery).  In addition, many in the medical community consider such procedures cosmetic surgery which is excluded by 1862 (a)(10) of the Act.  Therefore, ra dial keratotomy and keratoplasty to treat refractive defects are not covered.   80.7.1 - Keratoplasty  (Rev. 1, 10- 03-03)  Keratoplasty that treats specific lesions of the cornea, such as phototherapeutic keratectomy that removes scar tissue from the visual field, deals with an abnormality of the eye and is not cosmetic surgery.  Such cases may be covered under 1862(a)(1)(A) of the Act.   The use of lasers to treat ophthalmic  disease constitutes opthalmalogic surgery.  Coverage is restricted to practitioners who have completed an approved training program in ophthalmologic surgery.  80.8 - Endothelial Cell Photography  (Rev. 1, 10- 03-03) CIM 50 -38
(Medicare National Coverage Determinations Manual)
Endothelial cell photography involves the use of a specular microscope to determine the endothelial cell count.  It is used by ophthalmologists as a predictor of success of ocular surgery or certain other ocular procedures.  Endothelial cell photography is a covered procedure under Medicare when reasonable and necessary for patients who meet one or more of the following criteria:   Have slit lamp evidence of endothelial dystrophy (cornea guttata),   Have slit lamp evidence of corneal edema (unilateral or bilateral),   Are about to undergo a secondary intraocular lens implantation,  Have had previous intraocular surgery and require cataract surgery,   Are about to undergo a surgical procedure associated with a higher risk to corneal endothelium; i.e., phacoemulsification, or refractive surgery (see 80.7 for excluded refractive procedures),   With evidence of posterior polymorphous dystrophy of the cornea or irido-corneal -endothelium syndrome, or   Are about to be fitted with extended wear contact lenses after intraocular surgery.   When a presurgical examination for cataract surgery is performed and the conditions of this section are met, if the only visual problem is cataracts, endothelia l cell photography is covered as part of the presurgical comprehensive eye examination or combination brief/intermediate examination provided prior to cataract surgery, and not in addition to it.  (See 10.1)   80.9 - Computer Enhanced Perimetry  (Rev. 1, 10- 03-03) CIM 50 -49  Computer enhanced perimetry involves the use of a micro- computer to measure visual sensitivity at preselected locations in the visual field.   It is a covered service when us ed in assessing visual fields in patients with glaucoma or other neuropathologic defects.   80.10 - Phaco -Emulsification Procedure - Cataract Extraction  (Rev. 1, 10- 03-03) CIM 35 -9  In view of recommendations of authoritative sources in the field of ophthal mology, the subject technique is viewed as an accepted procedure for removal of cataracts.  Accordingly, program reimbursement may be made for necessary services furnished in connection with cataract extraction utilizing the phaco- emulsification procedure.
(Medicare National Coverage Determinations Manual)
80.11 - Vitrectomy  (Rev. 48, Issued:  03- 17-06; Effective/Implementation Dates:  06 -19-06) CIM -  35-16  Vitrectomy may be considered reasonable and necessary for the following conditions:  vitreous loss incident to cataract surgery, vitreous opacities due to vitreous hemorrhage or other causes, retinal detachments secondary to vitreous strands, proliferative  retinopathy, and vitreous retraction.  See chapter 23 of the Medicare Claims Processing Manual for how to determine payment for physician vitrectomy services and the Medicare Claims Processing Manual, Chapter 14, Ambulatory Surgical Centers, 40, for how to determine payment for ASC facility vitrectomy services.  Also, see the Medicare Claims Processing Manual, Chapter 23, Fee Schedule Administration and Coding Requirements, 20.9, to identify when, for Medicare payment purposes, certain vitrectomy c odes are included in other codes or when codes for other services include vitrectomy codes.   80.12 - Intraocular Lenses (IOLs)  (Rev. 1, 10- 03-03) CIM 65 -7  An intraocular lens, or pseudophakos, is an artificial lens which may be implanted to replace the natural lens after cataract surgery.  Intraocular lens implantation services, as well as the lens itself, may be covered if reasonable and necessary for the individual. Implantation services may include hospital, surgical, and other medical services, includi ng preimplantation ultrasound (A -scan) eye measurement of one or both eyes.   Cross -reference:   The Medicare Benefit Policy Manual, Chapter 6,Hospital Services Covered Under Part B, 10.  The Medicare Benefit Policy Manual, Chapter 15, Covered Medical an d Other Health Services, 120.   The Medicare Benefit Policy Manual, Chapter 16, General Exclusions from Coverage, 20 and 90.  Transmittals Issued for this Chapter
(Medicare National Coverage Determinations Manual)
The Medicare Benefit Policy Manual, Chapter 16, General Exclusions from Coverage, 20 and 90.  Transmittals Issued for this Chapter   Rev.#  Issue Date  Subject  Impl. Date  CR R12112NCD  06/29/2023  Technical Revisions Only to the National Coverage Determination (NCD) Manual, Publication (Pub) 100-03 07/31/2023  13220  R11892NCD   03/09/2023  Technical Revisions Only to the National Coverage Determination (NCD) Manual  04/10/2023  13105  R11875NCD  02/23/2023  National Coverage  Determination (NCD) 50.3 -  Cochlear Implantation Manual Update  03/24/2023  13073  R10985NCD  09/08/2021  Claims Processing Instructions for National Coverage Determination 20.33 -  Transcatheter Edge- to-Edge Repair [TEER] for Mitral Valve Regurgitation  10/08/2021  12361  R10838NCD  06/08/2021  National Coverage Determination (NCD) Removal  06/22/2021  12254  R10837NCD  06/11/2021  National Coverage Determination (NCD) 20.9.1 Ventricular Assist Devices (VADs)
(Medicare National Coverage Determinations Manual)
07/27/2021  12290  R10797NCD  05/20/2021  National Coverage Determination (NCD) Removal - Rescinded and replaced by Transmittal 10838  06/22/2021  12254  R10337NCD  08/27/2020  National Coverage Determination (NCD30.3.3): Acupuncture for Chronic Low Back Pain (cLBP)  10/05/2020  11755  R10128NCD  05/08/2020  National Coverage Determination (NCD30.3.3): Acupuncture for Chronic Low Back Pain (cLBP) - Rescinded and replaced by Transmittal 10337  10/05/2020  11755  R10179NCD  06/10/2020  NCD (20.32) Transcatheter Aortic Valve Replacement (TAVR)  06/12/2020  1166 0 R217NCD  03/13/2020  NCD (20.32) Transcatheter Aortic Valve Replacement (TAVR) - Rescinded and replaced by Transmittal 10179  06/12/2020  11660  R213NCD  02/15/2019  National Coverage Determination (NCD) 20.4 Implantable Cardiac Defibrillators (ICDs)  03/26/2019  10865  R209NCD  11/21/2018  National Coverage Determination (NCD) 20.4 Implantable Cardiac 02/26/2019  10865  Rev.#  Issue Date  Subject  Impl. Date  CR Defibrillators (ICDs)   Rescinded and replaced by Transmittal 211  R212NCD  01/18/2019  Update to Pub. 100 -03 to Provide Language -Only Changes for the New Medicare Card Project  02/19/2019  11118  R207NCD  05/11/2018  Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD)  07/02/2018  1029 5 R206NCD  04/03/2018  Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) - Rescinded and replaced by Transmittal 207  07/02/2018  10295  R204NCD  02/02/2018  Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD)  04/03/2018  1029 5 R203NCD  11/17/2017  Hyperbaric Oxygen (HBO) Therapy
(Medicare National Coverage Determinations Manual)
02/02/2018  Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD)  04/03/2018  1029 5 R203NCD  11/17/2017  Hyperbaric Oxygen (HBO) Therapy (Section C, Topical Application of Oxygen)  12/18/2017  10220  R201NCD  08/28/2017  National Coverage Determination (NCD20.8.4): Leadless Pacemakers
(Medicare National Coverage Determinations Manual)
08/29/2017  10117  R192NCD  05/06/2016  Percutaneous Left Atrial Appendage Closure (LAAC)  10/03/2016  9638  R187NCD  12/102015  National Coverage Determination (NCD) for Single Chamber and Dual Chamber Permanent Cardiac Pacemakers -  This CR rescinds and fully re places CR 8525  01/13/2016  9078  R186NCD  10/26/2015  National Coverage Determination (NCD) for Single Chamber and Dual Chamber Permanent Cardiac Pacemakers -  This CR rescinds and fully replaces CR 8525  Rescinded and replaced by Transmittal 187  07/06/2015  9078  R184NCD  08/21/2015  Update to Pub. 100 -03, National Coverage Determination Manual, Chapter 1, Part 1, Section 50.1 Speech Generating Device  09/21/2015  9281  R182NCD  05/22/2015  NCD20.30 Microvolt T -wave Alternans (MTWA)  06/23/2015  9162  R180NCD  03/06/2015  Removal of Multiple National Coverage Determinations Using Expedited Process  04/06/2015  9095  Rev.#  Issue Date  Subject  Impl. Date  CR R179NCD  02/20/2015  National Coverage Determination (NCD) for Single Chamber and Dual Chamber Permanent Cardiac Pacemakers -  This CR rescinds and fully replaces CR 8525  Rescinded and replaced by Transmittal 186  07/06/2015  9078  R178NCD  12/05/2014  Transcatheter Mitral Valve Repair (TMVR)- National Coverage Determination (NCD)  04/06/2015  9002  R175NCD  10/03/2014  Intensive Cardiac Rehabilitation Program -  Benson- Henry Institute Cardiac Wellness Program  11/04/2014  8894  R173NCD  09/04/2014  Pub 100 -03, Chapter 1, Language -only Update  Upon Implementation of ICD-10 8506  R172NCD  08/29/2014  Ventricular Assist Devices for Bridge -to-Transplant and Destination Therapy  09/30/2014  8803  R170NCD  07/10/2014  National Coverage Determination (NCD) for Single Chamber and Dual Chamber Permanent Cardiac Pacemaker s  Fully rescinded and replaced by CR 9078  To Be Determined  8525
(Medicare National Coverage Determinations Manual)
8803  R170NCD  07/10/2014  National Coverage Determination (NCD) for Single Chamber and Dual Chamber Permanent Cardiac Pacemaker s  Fully rescinded and replaced by CR 9078  To Be Determined  8525  R161NCD  02/06/2014  National Coverage Determination (NCD) for Single Chamber and Dual Chamber Permanent Cardiac Pacemakers  Rescinded and replaced by Transmittal 170  07/07/2014  8525  R159NCD  02/05/2014  Pub 100 -03, Chapter 1, Language -only Update  Rescinded and replaced by Transmittal 173  10/01/2014  8506  R158NCD  12/23/2013  Bariatric Surgery for Treatment of Co-Morbid Conditions Related to Morbid Obesity  12/17/2013  8484  R157NCD  11/15/2013  Bariatric Surgery for Treatment of Co-Morbid Conditions Related to Morbid Obesity  Rescinded and replaced by Transmittal 158  12/17/2013  8484  R155NCD  06/14/2013  Ocular Photodynamic Therapy (OPT) with Verteporfin for Macular Degeneration  07/16/2013  8292  R151NCD  02/08/2013  Change of Address for Percutaneous Transluminal 03/11/2013  8199  Rev.#  Issue Date  Subject  Impl. Date  CR Angioplasty (PTA) of the Carotid Artery Concurrent with Ste nting Facility Approval and Recertification Letter Submission  R149NCD  11/30/2012  Transcutaneous Electrical Nerve Stimulation (TENS) for Chronic Low Back Pain (CLBP)  01/07/2013  7836  R147NCD  09/24/2012  National Coverage Determination (NCD) for Transcatheter Aortic Valve Replacement  01/07/2013  7897  R145NCD  08/03/2012  National Coverage Determination (NCD) for Transcatheter Aortic Valve Replacement  Rescinded and replac ed by Transmittal 147  01/07/2013  7897  R144NCD  08/03/2012  Transcutaneous Electrical Nerve Stimulation (TENS) for Chroni c Low Back Pain (CLBP)  Rescinded and replaced by Transmittal 149  01/07/2013  7836  R129NCD  12/08/2010  Ventricular Assist Devices
(Medicare National Coverage Determinations Manual)
Nerve Stimulation (TENS) for Chroni c Low Back Pain (CLBP)  Rescinded and replaced by Transmittal 149  01/07/2013  7836  R129NCD  12/08/2010  Ventricular Assist Devices (VAD) as Destination Therapy  01/06/2011  7220  R128NCD  11/19/2010  Ventricular Assist Devices (VAD) as Destination Therapy -  Rescinded and replaced by Transmittal 129  01/06/2011  7220  R125NCD  09/24/2010  Intensive Cardiac Rehabilitation (ICR) Programs -Dr. Ornishs Program for Reversing Heart Disease and the Pritikin Program  10/25/2010  7113  R117NCD  03/09/2010  Outpatient Intravenous Insulin Treatment (Therapy)  04/05/2010  6775  R116NCD  03/05/2010  Repeal of Section 20.10, Cardiac Rehabilitation (CR) Program  04/05/2010  6855  R115NCD  03/05/2010  Percutaneous Transluminal Angioplasty (PTA) of the Carotid Artery Concurrent With Stenting  04/05/2010  6839  R114NCD  02/22/2010  Outpatient Intravenous Insulin Treatment (Therapy)  Rescinded and replaced by Transmittal 117  03/08/2010  6775  R112NCD  02/05/2010  Outpatient Intravenous Insulin Treatment (Therapy) -  Rescinded and replaced by Transmittal 114  03/08/2010  6775  R98NCD  12/24/2008  Percutaneous Transluminal Angioplasty of the Carotid Artery Concurrent With Stenting  01/26/2009  6301  Rev.#  Issue Date  Subject  Impl. Date  CR R95NCD  09/10/2008  Artificial Hearts  12/01/2008  6185  R93NCD  08/29/2008  Artificial Hearts - Replaced by Transmittal 95  10/06/2008  6185  R88NCD  07/25/2008  Microvolt T -Wave Alterans (MTWA)  08/25/2008  6154  R87NCD  07/11/2008  Percutaneous Transluminal Angioplasty (PTA) With Stenting  08/11/2008  6137  R81NCD  04/04/2008  Percutaneous Transluminal Angioplasty
(Medicare National Coverage Determinations Manual)
Percutaneous Transluminal Angioplasty (PTA) With Stenting  08/11/2008  6137  R81NCD  04/04/2008  Percutaneous Transluminal Angioplasty (PTA)  05/05/2008  5984  R77NCD  09/12/2007  Percutaneous Transluminal Angioplasty (PTA)  07/30/2007  5660  R71NCD  06/29/2007  Percutaneous Transluminal Angioplasty (PTA) -  Replaced by Transmittal 77  07/30/2007  5660  R68NCD  04/13/2007  Ventricular Assist Devices (VADs)  05/14/2007  5516  R64NCD  01/05/2007  Intracranial Percutaneous Transluminal Angioplasty (PTA) with Stenting  02/05/2007  5432  R63NCD  12/15/2006  Cardiac Output Monitoring by Thoracic Electrical Bioimpedance (TEB)  01/16/2007  5414  R54NCD  04/28/2006  Bariatric Surgery for Treatment of Morbid Obesity  05/30/2006  5013  R53NCD  04/21/2006  Clarification on Billing Requirements for Percutaneous Transluminal Angioplasty (PTA) Concurrent with t he Placement of an Investigational or FDA -Approved Carotid Stent  N/A 5022  R52NCD  04/21/2006  Cardiac Rehabilitation Pr ograms  06/21/2006  4401  R50NCD  03/31/2006  External Counterpulsation Therapy  04/03/2006  4350  R49NCD  03/24/2006  Microvolt T -Wave Alternans (MTWA) Diagnostic Testing  04/03/2006  4351  R48NCD  03/17/2006  Technical Corrections to the NCD Manual  06/19/2006  4278  R46NCD  01/27/2006  Cardiac Catheterization Performed in Other Than a Hospital Setting  02/27/2006  4280  R42NCD  07/01/2005  Cochlear Implantation  07/25/2005  3796  R39NCD  06/24/2005  Cochlear Implantation - Replaced by Revision 42  07/05/2005  3796  R33NCD  04/22/2005  Percutaneous Transluminal