New Local Coverage Determinations Issued for Idaho and Oregon
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Medicare Policies and Guildelines
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The following new Local Coverage Determinations (LCDs) have been issued for the states of Idaho and Oregon:
o Blepharoplasty, Blepharoptosis, and Brow Lift: Blepharoplasty, blepharoptosis, and lid reconstruction may be defined as any eyelid surgery that improves abnormal function, reconstructs deformities, or enhances appearance. They may be either functional/reconstructive or cosmetic. This LCD addresses what is considered reasonable and medically necessary for payment. Cosmetic procedures are excluded from payment.
o Botulinum Toxins Types A and B: Botulinum toxin injections are used to treat various focal muscle spastic disorders and excessive muscle contractions such as dystonias, spasms, twitches, etc. This LCD addresses what is considered reasonable and medically necessary for payment. Cosmetic procedures and treatments are excluded from payment under Medicare law.
o Facet Joint and Medial Nerve Blockade: Nerve blocks are some of the many modalities utilized in the diagnostic and therapeutic management of acute and chronic pain. This LCD addresses the reasonable and medically necessary requirements for payment.
o Immune Globulin Intravenous (IGIV): IgIV is a solution of human immunoglobulins specifically prepared for intravenous infusion. This LCD addresses the reasonable and medically necessary requirements for payment.
o Magnesium: Magnesium is a mineral required by the body for the use of adenosine triphosphate (ATP) as a source of energy. This LCD addresses the reasonable and medically necessary requirements for payment.
o Nerve Blockade: Somatic, Selective Nerve Root, and Epidural: This LCD solely addresses the use of these blocks in the definition and treatment of pain. This LCD addresses the reasonable and medically necessary requirements for payment.
o Non-Malignant Skin Lesion Removal: This LCD only applies to the following: seborrheic keratosis, skin tag, milium, molluscum contagiosum, sebaceous (epidermoid) cyst, mole (nevus), acquired hyperkeratosis (keratoderma), and viral wart (excluding condyloma accuminatum). This policy does not apply to MOHS. The treatment of actinic keratosis is covered in another policy. This LCD addresses the reasonable and medically necessary requirements for payment.
o Urinalysis: Urinalysis is a commonly used physical, chemical, and/or microscopic examination of the urine used to detect renal or urinary tract disease or systemic disorders manifested by or through the urinary system. This LCD addresses the conditions and diagnoses reasonable and medically necessary for payment.
o Vitamin B12 Injection Policy: This LCD addresses treatment with injectable Vitamin B12. This LCD addresses the reasonable and medically necessary requirements for payment.
Please review these policies on the NAS website at www.noridianmedicare.com. Select Medicare Part A. Read the "End User Agreement for Providers" and select Accept. Select "Medical Review/Medical Policies" under the "News and Publications" heading. Select "Draft Medical Policies" under the "Medical Review" heading. Select "OR, ID" under the "Part A Policies" heading. Select the policy for review.
Comments will be accepted for these policies from January 31, 2007 to March 17, 2007.
You may fax your comments to 701-277-6605-4 ATTN: Draft LCD Comments.
You may email your comments to: policya.drafts@noridian.com
You may mail your comments to:
Noridian Administrative Services, LLC Medicare Part A-Policy A Drafts 901 40th St South Suite 1 PO Box 6726 Fargo ND 58108-6732
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