evekhm/cms_iom_500 huggingface dataset:
(Medicare Claims Processing Manual)
037G34Z  Dilation of Intracranial Artery with Drug -eluting Intraluminal Device, Percutaneous Approach  037G35Z  Dilation of Intracranial Artery with Two Drug -eluting Intraluminal Devices, Percutaneous Approach  037G36Z  Dilation of Intracranial Artery with Three Drug -eluting Intraluminal Devices, Percutaneous Approach  037G37Z  Dilation of Intracranial Artery with Four or More Drug -eluting Intraluminal Devices, Percutan  Approach  037G3DZ  Dilation of Intracranial Artery with Intraluminal Device, Percutaneous Approach  037G3EZ  Dilation of Intracranial Artery with Two Intraluminal Devices, Percutaneous Approach  037G3FZ  Dilation of Intracranial Artery with Three Intraluminal Devices, Percutaneous Approach  037G3GZ  Dilation of Intracranial Artery with Four or More Intraluminal Devices, Percutaneous Approa  037G44Z  Dilation of Intracranial Artery with Drug -eluting Intraluminal Device, Percutaneous Endoscop  Approach  037G45Z  Dilation of Intracranial Artery with Two Drug -eluting Intraluminal Devices, Percutaneous Endoscopic Approach  037G46Z  Dilation of Intracranial Artery with Three Drug -eluting Intraluminal Devices, Percutaneous Endoscopic Approach  037G47Z  Dilation of Intracranial Artery with Four or More Drug -eluting Intraluminal Devices, Percutan  Endoscopic Approach  037G4DZ  Dilation of Intracranial Artery with Intraluminal Device, Percutaneous Endoscopic Approach  037G4EZ  Dilation of Intracranial Artery with Two Intraluminal Devices, Percutaneous Endoscopic Approach  037G4FZ  Dilation of Intracranial Artery with Three Intraluminal Devices, Percutaneous Endoscopic Approach  037G4GZ  Dilation of Intracranial Artery with Four or More Intraluminal Devices, Percutaneous Endosc  Approach  037H34Z  Dilation of Right Common Carotid Artery with Drug -eluting Intraluminal Device, Percutaneo  Approach  037H35Z  Dilation of Right Common Carotid Artery with Two Drug -eluting Intraluminal Devices, Percutaneous Approach  037H36Z
(Medicare Claims Processing Manual)
Artery with Drug -eluting Intraluminal Device, Percutaneo  Approach  037H35Z  Dilation of Right Common Carotid Artery with Two Drug -eluting Intraluminal Devices, Percutaneous Approach  037H36Z  Dilation of Right Common Carotid Artery with Three Drug -eluting Intraluminal Devices, Percutaneous Approach  037H37Z  Dilation of Right Common Carotid Artery with Four or More Drug -eluting Intraluminal Devi  Percutaneous Approach  037H3DZ  Dilation of Right Common Carotid Artery with Intraluminal Device, Percutaneous Approach  037H3EZ  Dilation of Right Common Carotid Artery with Two Intraluminal Devices, Percutaneous Approach  037H3FZ  Dilation of Right Common Carotid Artery with Three Intraluminal Devices, Percutaneous Approach  037H3GZ  Dilation of Right Common Carotid Artery with Four or More Intraluminal Devices, Percutane  Approach  037H44Z  Dilation of Right Common Carotid Artery with Drug -eluting Intraluminal Device, Percutaneo  Endoscopic Approach  037H45Z  Dilation of Right Common Carotid Artery with Two Drug -eluting Intraluminal Devices, Percutaneous Endoscopic Approach  037H46Z  Dilation of Right Common Carotid Artery with Three Drug -eluting Intraluminal Devices, Percutaneous Endoscopic Approach  037H47Z  Dilation of Right Common Carotid Artery with Four or More Drug -eluting Intraluminal Devi  Percutaneous Endoscopic Approach  037H4DZ  Dilation of Right Common Carotid Artery with Intraluminal Device, Percutaneous Endoscopi  Approach  037H4EZ  Dilation of Right Common Carotid Artery with Two Intraluminal Devices, Percutaneous Endoscopic Approach  037H4FZ  Dilation of Right Common Carotid Artery with Three Intraluminal Devices, Percutaneous Endoscopic Approach  037H4GZ  Dilation of Right Common Carotid Artery with Four or More Intraluminal Devices, Percutane  Endoscopic Approach  037J34Z  Dilation of Left Common Carotid Artery with Drug -eluting Intraluminal Device, Percutaneou  Approach  037J35Z  Dilation of Left Common Carotid Artery with Two Drug
(Medicare Claims Processing Manual)
Endoscopic Approach  037J34Z  Dilation of Left Common Carotid Artery with Drug -eluting Intraluminal Device, Percutaneou  Approach  037J35Z  Dilation of Left Common Carotid Artery with Two Drug -eluting Intraluminal Devices, Percutaneous Approach  037J36Z  Dilation of Left Common Carotid Artery with Three Drug -eluting Intraluminal Devices, Percutaneous Approach  037J37Z  Dilation of Left Common Carotid Artery with Four or More Drug -eluting Intraluminal Device  Percutaneous Approach  037J3DZ  Dilation of Left Common Carotid Artery with Intraluminal Device, Percutaneous Approach  037J3EZ  Dilation of Left Common Carotid Artery with Two Intraluminal Devices, Percutaneous Appro  037J3FZ  Dilation of Left Common Carotid Artery with Three Intraluminal Devices, Percutaneous App  037J3GZ  Dilation of Left Common Carotid Artery with Four or More Intraluminal Devices, Percutaneo  Approach  037J44Z  Dilation of Left Common Carotid Artery with Drug -eluting Intraluminal Device, Percutaneou  Endoscopic Approach  037J45Z  Dilation of Left Common Carotid Artery with Two Drug -eluting Intraluminal Devices, Percutaneous Endoscopic Approach  037J46Z  Dilation of Left Common Carotid Artery with Three Drug -eluting Intraluminal Devices, Percutaneous Endoscopic Approach  037J47Z  Dilation of Left Common Carotid Artery with Four or More Drug -eluting Intraluminal Device  Percutaneous Endoscopic Approach  037J4DZ  Dilation of Left Common Carotid Artery with Intraluminal Device, Percutaneous Endoscopic Approach  037J4EZ  Dilation of Left Common Carotid Artery with Two Intraluminal Devices, Percutaneous Endoscopic Approach  037J4FZ  Dilation of Left Common Carotid Artery with Three Intraluminal Devices, Percutaneous Endoscopic Approach  037J4GZ  Dilation of Left Common Carotid Artery with Four or More Intraluminal Devices, Percutaneo  Endoscopic Approach  037K34Z  Dilation of Right Internal Carotid Artery with Drug -eluting Intraluminal Device, Percutaneou
(Medicare Claims Processing Manual)
Common Carotid Artery with Four or More Intraluminal Devices, Percutaneo  Endoscopic Approach  037K34Z  Dilation of Right Internal Carotid Artery with Drug -eluting Intraluminal Device, Percutaneou  Approach  037K35Z  Dilation of Right Internal Carotid Artery with Two Drug -eluting Intraluminal Devices, Percutaneous Approach  037K36Z  Dilation of Right Internal Carotid Artery with Three Drug -eluting Intraluminal Devices, Percutaneous Approach  037K37Z  Dilation of Right Internal Carotid Artery with Four or More Drug -eluting Intraluminal Device  Percutaneous Approach  037K3DZ  Dilation of Right Internal Carotid Artery with Intraluminal Device, Percutaneous Approach  037K3EZ  Dilation of Right Internal Carotid Artery with Two Intraluminal Devices, Percutaneous Appro  037K3FZ  Dilation of Right Internal Carotid Artery with Three Intraluminal Devices, Percutaneous Appr  037K3GZ  Dilation of Right Internal Carotid Artery with Four or More Intraluminal Devices, Percutaneo  Approach  037K44Z  Dilation of Right Internal Carotid Artery with Drug -eluting Intraluminal Device, Percutaneou  Endoscopic Approach  037K45Z  Dilation of Right Internal Carotid Artery with Two Drug -eluting Intraluminal Devices, Percutaneous Endoscopic Approach  037K46Z  Dilation of Right Internal Carotid Artery with Three Drug -eluting Intraluminal Devices, Percutaneous Endoscopic Approach  037K47Z  Dilation of Right Internal Carotid Artery with Four or More Drug -eluting Intraluminal Device  Percutaneous Endoscopic Approach  037K4DZ  Dilation of Right Internal Carotid Artery with Intraluminal Device, Percutaneous Endoscopic Approach  037K4EZ  Dilation of Right Internal Carotid Artery with Two Intraluminal Devices, Percutaneous Endoscopic Approach  037K4FZ  Dilation of Right Internal Carotid Artery with Three Intraluminal Devices, Percutaneous Endoscopic Approach  037K4GZ  Dilation of Right Internal Carotid Artery with Four or More Intraluminal Devices, Percutaneo  Endoscopic Approach  037L34Z  Dilation of Left
(Medicare Claims Processing Manual)
Devices, Percutaneous Endoscopic Approach  037K4GZ  Dilation of Right Internal Carotid Artery with Four or More Intraluminal Devices, Percutaneo  Endoscopic Approach  037L34Z  Dilation of Left Internal Carotid Artery with Drug -eluting Intraluminal Device, Percutaneous Approach  037L35Z  Dilation of Left Internal Carotid Artery with Two Drug -eluting Intraluminal Devices, Percutaneous Approach  037L36Z  Dilation of Left Internal Carotid Artery with Three Drug -eluting Intraluminal Devices, Percutaneous Approach  037L37Z  Dilation of Left Internal Carotid Artery with Four or More Drug -eluting Intraluminal Devices  Percutaneous Approach  037L3DZ  Dilation of Left Internal Carotid Artery with Intraluminal Device, Percutaneous Approach  037L3EZ  Dilation of Left Internal Carotid Artery with Two Intraluminal Devices, Percutaneous Approa  037L3FZ  Dilation of Left Internal Carotid Artery with Three Intraluminal Devices, Percutaneous Appro  037L3GZ  Dilation of Left Internal Carotid Artery with Four or More Intraluminal Devices, Percutaneou  Approach  037L44Z  Dilation of Left Internal Carotid Artery with Drug -eluting Intraluminal Device, Percutaneous Endoscopic Approach  037L45Z  Dilation of Left Internal Carotid Artery with Two Drug -eluting Intraluminal Devices, Percutaneous Endoscopic Approach  037L46Z  Dilation of Left Internal Carotid Artery with Three Drug -eluting Intraluminal Devices, Percutaneous Endoscopic Approach  037L47Z  Dilation of Left Internal Carotid Artery with Four or More Drug -eluting Intraluminal Devices  Percutaneous Endoscopic Approach  037L4DZ  Dilation of Left Internal Carotid Artery with Intraluminal Device, Percutaneous Endoscopic Approach  037L4EZ  Dilation of Left Internal Carotid Artery with Two Intraluminal Devices, Percutaneous Endosc  Approach  037L4FZ  Dilation of Left Internal Carotid Artery with Three Intraluminal Devices, Percutaneous Endoscopic Approach  037L4GZ  Dilation of Left Internal Carotid Artery with Four or More Intraluminal
(Medicare Claims Processing Manual)
Dilation of Left Internal Carotid Artery with Three Intraluminal Devices, Percutaneous Endoscopic Approach  037L4GZ  Dilation of Left Internal Carotid Artery with Four or More Intraluminal Devices, Percutaneou  Endoscopic Approach  037M34Z  Dilation of Right External Carotid Artery with Drug -eluting Intraluminal Device, Percutaneou  Approach  037M35Z  Dilation of Right External Carotid Artery with Two Drug -eluting Intraluminal Devices, Percutaneous Approach  037M36Z  Dilation of Right External Carotid Artery with Three Drug -eluting Intraluminal Devices, Percutaneous Approach  037M37Z  Dilation of Right External Carotid Artery with Four or More Drug -eluting Intraluminal Devic  Percutaneous Approach  037M3DZ  Dilation of Right External Carotid Artery with Intraluminal Device, Percutaneous Approach  037M3EZ  Dilation of Right External Carotid Artery with Two Intraluminal Devices, Percutaneous Appr  037M3FZ  Dilation of Right External Carotid Artery with Three Intraluminal Devices, Percutaneous Approach  037M3GZ  Dilation of Right External Carotid Artery with Four or More Intraluminal Devices, Percutaneo  Approach  037M44Z  Dilation of Right External Carotid Artery with Drug -eluting Intraluminal Device, Percutaneou  Endoscopic Approach  037M45Z  Dilation of Right External Carotid Artery with Two Drug -eluting Intraluminal Devices, Percutaneous Endoscopic Approach  037M46Z  Dilation of Right External Carotid Artery with Three Drug -eluting Intraluminal Devices, Percutaneous Endoscopic Approach  037M47Z  Dilation of Right External Carotid Artery with Four or More Drug -eluting Intraluminal Devic  Percutaneous Endoscopic Approach  037M4DZ  Dilation of Right External Carotid Artery with Intraluminal Device, Percutaneous Endoscopic Approach  037M4EZ  Dilation of Right External Carotid Artery with Two Intraluminal Devices, Percutaneous Endoscopic Approach  037M4FZ  Dilation of Right External Carotid Artery with Three Intraluminal Devices, Percutaneous Endoscopic Approach  037M4GZ
(Medicare Claims Processing Manual)
Artery with Two Intraluminal Devices, Percutaneous Endoscopic Approach  037M4FZ  Dilation of Right External Carotid Artery with Three Intraluminal Devices, Percutaneous Endoscopic Approach  037M4GZ  Dilation of Right External Carotid Artery with Four or More Intraluminal Devices, Percutaneo  Endoscopic Approach  037N34Z  Dilation of Left External Carotid Artery with Drug -eluting Intraluminal Device, Percutaneous Approach  037N35Z  Dilation of Left External Carotid Artery with Two Drug -eluting Intraluminal Devices, Percutaneous Approach  037N36Z  Dilation of Left External Carotid Artery with Three Drug -eluting Intraluminal Devices, Percutaneous Approach  037N37Z  Dilation of Left External Carotid Artery with Four or More Drug -eluting Intraluminal Device  Percutaneous Approach  037N3DZ  Dilation of Left External Carotid Artery with Intraluminal Device, Percutaneous Approach  037N3EZ  Dilation of Left External Carotid Artery with Two Intraluminal Devices, Percutaneous Appro  037N3FZ  Dilation of Left External Carotid Artery with Three Intraluminal Devices, Percutaneous Appr  037N3GZ  Dilation of Left External Carotid Artery with Four or More Intraluminal Devices, Percutaneou  Approach  037N44Z  Dilation of Left External Carotid Artery with Drug -eluting Intraluminal Device, Percutaneous Endoscopic Approach  037N45Z  Dilation of Left External Carotid Artery with Two Drug -eluting Intraluminal Devices, Percutaneous Endoscopic Approach  037N46Z  Dilation of Left External Carotid Artery with Three Drug -eluting Intraluminal Devices, Percutaneous Endoscopic Approach  037N47Z  Dilation of Left External Carotid Artery with Four or More Drug -eluting Intraluminal Device  Percutaneous Endoscopic Approach  037N4DZ  Dilation of Left External Carotid Artery with Intraluminal Device, Percutaneous Endoscopic Approach  037N4EZ  Dilation of Left External Carotid Artery with Two Intraluminal Devices, Percutaneous Endos  Approach  037N4FZ  Dilation of Left External Carotid Artery with Three
(Medicare Claims Processing Manual)
Endoscopic Approach  037N4EZ  Dilation of Left External Carotid Artery with Two Intraluminal Devices, Percutaneous Endos  Approach  037N4FZ  Dilation of Left External Carotid Artery with Three Intraluminal Devices, Percutaneous Endoscopic Approach  037N4GZ  Dilation of Left External Carotid Artery with Four or More Intraluminal Devices, Percutaneou  Endoscopic Approach
(Medicare Claims Processing Manual)
Under Part B, providers must bill HCPCS procedure code 37799. If above ICD -10-CM is applicable.    NOTE: ICD-  codes are subject to modification. Providers must always ensure they are  using the latest and most appropriate codes.   170 - Billing Requirements for Lumbar Artificial Disc Replacement  (Rev. 992, Issued: 06- 23-06, Effective: 05 -16-06, Implementation: Carriers 07- 17-06/FIs 10- 01-06)  170.1 - General  (Rev. 1340, Issued: 09- 21-07, Effective: 08 -14-07, Implementation: 10- 01-07)  Effective for services performed from May 16, 2006 through August 13, 2007, the Centers for Medicare & Medicaid Services (CMS) made the decision that lumbar artificial disc replacement (LADR) with the ChariteTM lumbar artificial disc is non -covered for Medicare beneficiaries over 60 years of age.  See Pub. 100-03, Medicare National Coverage Determinations Manual, section 150.10, for more information about the non-covered determination.   Effective for services performed on or after  August 14, 2007, CMS made the decision that LADR with any lumbar artificial disc is non -covered for Medicare beneficiaries over 60 years of age, (i.e., on or after a beneficiarys 61st birthday).  For Medicare beneficiaries 60 years of age and younger, there is no national coverage determination for LADR, leaving such determinations to continue to be made by the local contractors.   170.2 - Carrier Billing Requirements  (Rev. 11902; Issued:03- 16-23; Effective: 04 -17-23; Implementation: 04 -17-23)  Effective for services performed on or after  May 16, 2006 through December 31, 2006, carriers shall deny claims, for Medicare beneficiaries over 60 years of age, submitted with the following Category III Codes:    0091T  Single interspace, lumbar; and
(Medicare Claims Processing Manual)
 0091T  Single interspace, lumbar; and   0092T  Each additional interspace (List separately in addition to code for primary procedure.)  Effective for services performed on or after  January 1, 2007 through August 13, 2007, for Medicare beneficiaries over 60 years of age, LADR with the ChariteTM lumbar artificial disc, carriers shall deny claims submitted with the following codes:    22857 Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression), lumbar, single interspace    0163T  Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression), lumbar, each additional interspace. NOTE: Effective December 31, 2022, code 0163T is end dated.    Carriers shall continue to follow their normal claims processing criteria for IDEs for LADR performed with an implant eligible under the IDE criteria.   For dates of service May 16, 2006 through August 13, 2007, Medicare coverage under the investigational device exemption (IDE) for LADR with a disc other than the ChariteTM lumbar disc in eligible clinical trials is not impacted.  Effective for services performed on or after  August 14, 2007, carriers shall deny claims for LADR surgery, for Medicare beneficiaries over 60 years of age, (i.e., on or after a beneficiarys 61st birthday) submitted with the following codes:    22857 Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression), lumbar, single interspace   0163T     Total disc arthroplasty (artificial disc), anterior approach, including                  discectomy to prepare interspace (other than for decompression), lumbar, each    additional interspace NOTE: Effective December 31, 2022, code 0163T is end   dated.   22860 Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression); second interspace, lumbar. Effective 01/01/23
(Medicare Claims Processing Manual)
170.3 - A/B MAC (A)  Billing Requirements  (Rev.  2998, Issued: 07- 25-14, Effective: Upon implementation of ICD -10; 01- 01-12 - ASC X12, Implementation: 08 -25-2014 -  ASC X12; Upon Implementation of ICD -10)  The A/B MAC (A) will pay for LADR when approved under the IDE/clinical trial criteria only when submitted with ICD -9-CM procedure code 84.65 if ICD -9 is applicable,  with condition code 30 and if ICD -9-CM is applicable , ICD-9-CM diagnosis code V70.7  when submitted on type of bill (TOB) 11X from May 16, 2006 through August 13, 2007.  Special Billing instructions:  For services performed on TOB 11X in critical access hospitals (CAH), the payment will be 101% of reasonable cost.   For services performed on TOB 11X Indian Health Services (IHS) inpatient hospitals will pay under the inpatient prospective payment system (IPPS) based on the DRG.  For services performed on TOB 11X, IHS CAHs will pay under 101% facility specific per diem rate.   NOTE:   The ICD -9-CM procedure code 84.65 is not payable for beneficiaries over 60 years of age, with the ChariteTM lumbar artificial disc, which is the only one that is FDA approved for any diagnosis.  If a different manufactures disc is used in an approved clinical trials or is an approved IDE, then condition code 30 and ICD-9-CM diagnosis code V70.7 must be on the claim for it to be payable.   Effective for discharges on or after August 14, 2007, CMS has found that LADR is not reasonable and necessary for the Medicare population over 60 years of age.  Therefore, LADR is non- covered for Medicare beneficiaries over 60 years of age as identified in section 150.10, of Pub.100- 03, the NCD Manual.  A/B MACS (A) shall deny claims with ICD -9-CM procedure code 84.65 for Medicare beneficiaries over 60 years of age.
(Medicare Claims Processing Manual)
For Medicare beneficiaries 60 years of age and younger, there is no NCD, leaving such determinations to continue to be made by the local contractors.   170.4  Reasons for Denial and Medicare Summary Notice (MSN), Claim Adjustment Reason Code Messages, and Remittance Advice Remark Code  (Rev. 1340, Issued: 09- 21-07, Effective: 08 -14-07, Implementation: 10- 01-07)  Contractors shall use the following messages when denying claims for Medicare beneficiaries over 60 years of age (i.e. on or after a beneficiarys 61st birthday).  21.24 This service is not covered for patients over age 60.    Este servicio no est cubierto en pacientes mayores de 60 aos.   Use an appropriate Claim Adjustment Reason Code:   96 "Non -covered charge(s)."   Use an appropriate Remittance Advice Remark Code:   N386  This decision was based on a National Coverage Determination (NCD). An NCD provides a coverage determination as to whether a particular item or service is covered.  A copy of this policy is available at http://www.cms.hhs.gov/mcd/search.asp.  If you do not have Web access, you may contact the contractor to request a copy of the NCD.   170.5 - Advance Beneficiary Notice (ABN) and Hospital Issued Notice of Noncoverage (HINN) Information  (Rev. 1340, Issued: 09- 21-07, Effective: 08 -14-07, Implementation: 10- 01-07)
(Medicare Claims Processing Manual)
Providers must be advised that the provider is liable for charges if the lumbar artificial disc replacement is used in the surgery, unless the beneficiary was informed that he/she would be financially responsible prior to performance of the procedure.  To avoid this liability the provider should have the beneficiary sign an ABN.  The HINN model language should be adapted to this situation in the sections addressing description of the care at issue if the surgery is performed on an inpatient basis. Unless the beneficiary was informed prior to the admission that he/ she would be fina ncially liable for the admission, the provider is liable.  To avoid this liability the provider must issue a HINN. Other content requirements of a HINN still apply. Use the HINN letter most appropriate to the overall situation.   180  Cryosurgery of the Prostate Gland  (Rev. 1111, Issued: 11- 09-06, Effective: 04 -01-07, Implementation: 04- 02-07)  Cryosurgery of the prostate gland, also known as cryosurgical ablation of the prostate (CAP), destroys prostate tissue by applying extremely cold temperatures in order to reduce the size of the prostate gland.  180.1 - Coverage Requirements  (Rev. 1111, Issued: 11- 09-06, Effective: 04 -01-07, Implementation: 04- 02-07)  Medicare covers cryosurgery of the prostate gland effective for claims with dates of service on or after July 1, 1999.  The coverage is for:   1. Primary treatment of patients with clinically localized prostate cancer, Stages T1  T3 (diagnosis code is 185  malignant neoplasm of prostate).   2. Salvage therapy (effective for claims with dates of service on or after July 1, 2001 for patients:   a. Having recurrent, localized prostate cancer;   b. Failing a trial of radiation therapy as their primary treatment; and   c. Meeting one of these conditions:  State T2B or below; Gleason score less than 9 or; PSA less than 8 ng/ml.  180.2 - Billing Requirements (Rev.  2998, Issued: 07- 25-14, Effective: Upon implementation of ICD-10; 01-01-12 - ASC X12, Implementation: 08 -25-2014 - ASC X12; Upon Implementation of ICD-10)