The 2012 CPT/HCPCs have been reviewed and all affected LCD updated. The following are the affected LCDs and the updates will be implemented on January 01, 2012.
Application of Bioengineered Skin Substitutes: Ulcers of the Lower Extremities
Deleted CPT/HCPC Codes for non-covered procedures:
CPT/HCPC: 15170
DESCRIPTION: ACELLULAR DERMAL REPLACEMENT, TRUNK, ARMS, LEGS; FIRST 100 SQ CM OR LESS, OR 1% OF BODY AREA OF INFANTS AND CHILDREN
CPT/HCPC: 15171
DESCRIPTION: ACELLULAR DERMAL REPLACEMENT, TRUNK, ARMS, LEGS; EACH ADDITIONAL 100 SQ CM, OR EACH ADDITIONAL 1% OF BODY AREA OF INFANTS AND CHILDREN, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
CPT/HCPC: 15175
DESCRIPTION:ACELLULAR DERMAL REPLACEMENT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET, AND/OR MULTIPLE DIGITS; FIRST 100 SQ CM OR LESS, OR 1% OF BODY AREA OF INFANTS AND CHILDREN
CPT/HCPC: 15176
DESCRIPTION: ACELLULAR DERMAL REPLACEMENT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET, AND/OR MULTIPLE DIGITS; EACH ADDITIONAL 100 SQ CM, OR EACH ADDITIONAL 1% OF BODY AREA OF INFANTS AND CHILDREN, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
Deleted CPT/HCPC Codes for covered application procedures:
CPT/HCPC: 15340
DESCRIPTION: TISSUE CULTURED ALLOGENEIC SKIN SUBSTITUTE; FIRST 25 SQ CM OR LESS
CPT/HCPC: 15341
DESCRIPTION: TISSUE CULTURED ALLOGENEIC SKIN SUBSTITUTE; EACH ADDITIONAL 25 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
CPT/HCPC: 15360
DESCRIPTION: TISSUE CULTURED ALLOGENEIC DERMAL SUBSTITUTE, TRUNK, ARMS, LEGS; FIRST 100 SQ CM OR LESS, OR 1% OF BODY AREA OF INFANTS AND CHILDREN
CPT/HCPC: 15361
DESCRIPTION:TISSUE CULTURED ALLOGENEIC DERMAL SUBSTITUTE, TRUNK, ARMS, LEGS; EACH ADDITIONAL 100 SQ CM, OR EACH ADDITIONAL 1% OF BODY AREA OF INFANTS AND CHILDREN, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
CPT/HCPC: 15365
DESCRIPTION:TISSUE CULTURED ALLOGENEIC DERMAL SUBSTITUTE, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET, AND/OR MULTIPLE DIGITS; FIRST 100 SQ CM OR LESS, OR 1% OF BODY AREA OF INFANTS AND CHILDREN
CPT/HCPC: 15366
DESCRIPTION:TISSUE CULTURED ALLOGENEIC DERMAL SUBSTITUTE, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET, AND/OR MULTIPLE DIGITS; EACH ADDITIONAL 100 SQ CM, OR EACH ADDITIONAL 1% OF BODY AREA OF INFANTS AND CHILDREN, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
CPT/HCPC: 15430
DESCRIPTION:ACELLULAR XENOGRAFT IMPLANT; FIRST 100 SQ CM OR LESS, OR 1% OF BODY AREA OF INFANTS AND CHILDREN
CPT/HCPC: 15431
DESCRIPTION:ACELLULAR XENOGRAFT IMPLANT; FIRST 100 SQ CM OR LESS, OR 1% OF BODY AREA OF INFANTS AND CHILDREN TO CODE FOR PRIMARY PROCEDURE)
CPT/HCPC: G0440
DESCRIPTION:APPLICATION OF TISSUE CULTURED ALLOGENEIC SKIN SUBSTITUTE OR DERMAL SUBSTITUTE; FOR USE ON LOWER LIMB, INCLUDES THE SITE PREPARATION AND DEBRIDEMENT IF PERFORMED; FIRST 25 SQ CM OR LESS
CPT/HCPC: G0441
DESCRIPTION: APPLICATION OF TISSUE CULTURED ALLOGENEIC SKIN SUBSTITUTE OR DERMAL SUBSTITUTE; FOR USE ON LOWER LIMB, INCLUDES THE SITE PREPARATION AND DEBRIDEMENT IF PERFORMED; EACH ADDITIONAL 25 SQ CM
New CPT/HCPC Codes for non-covered products:
CPT/HCPC: C9366
DESCRIPTION: EPIFIX, PER SQUARE CENTIMETER
CPT/HCPC: Q4122
DESCRIPTION: DERMACELL, PER SQUARE CENTIMETER
CPT/HCPC: Q4123
DESCRIPTION:ALLOSKIN RT, PER SQUARE CENTIMETER
CPT/HCPC: Q4124
DESCRIPTION:OASIS ULTRA TRI-LAYER WOUND MATRIX, PER SQUARE CENTIMETER
CPT/HCPC:Q4125
DESCRIPTION:ARTHROFLEX, PER SQUARE CENTIMETER
CPT/HCPC: Q4126
DESCRIPTION:MEMODERM, PER SQUARE CENTIMETER
CPT/HCPC: Q4127
DESCRIPTION:TALYMED, PER SQUARE CENTIMETER
CPT/HCPC: Q4128
DESCRIPTION:FLEXHD OR ALLOPATCH HD, PER SQUARE CENTIMETER
CPT/HCPC:Q4129
DESCRIPTION:UNITE BIOMATRIX, PER SQUARE CENTIMETER
CPT/HCPC:Q4130
DESCRIPTION:STRATTICE TM, PER SQUARE CENTIMETER
CPT/HCPC:15271
DESCRIPTION:APPLICATION OF SKIN SUBSTITUTE GRAFT TO TRUNK, ARMS, LEGS, TOTAL WOUND SURFACE AREA UP TO 100 SQ CM; FIRST 25 SQ CM OR LESS WOUND SURFACE AREA
CPT/HCPC:15272
DESCRIPTION:APPLICATION OF SKIN SUBSTITUTE GRAFT TO TRUNK, ARMS, LEGS, TOTAL WOUND SURFACE AREA UP TO 100 SQ CM; EACH ADDITIONAL 25 SQ CM WOUND SURFACE AREA, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
CPT/HCPC: 15273
DESCRIPTION:APPLICATION OF SKIN SUBSTITUTE GRAFT TO TRUNK, ARMS, LEGS, TOTAL WOUND SURFACE AREA GREATER THAN OR EQUAL TO 100 SQ CM; FIRST 100 SQ CM WOUND SURFACE AREA, OR 1% OF BODY AREA OF INFANTS AND CHILDREN
CPT/HCPC:15274
DESCRIPTION:APPLICATION OF SKIN SUBSTITUTE GRAFT TO TRUNK, ARMS, LEGS, TOTAL WOUND SURFACE AREA GREATER THAN OR EQUAL TO 100 SQ CM; EACH ADDITIONAL 100 SQ CM WOUND SURFACE AREA, OR PART THEREOF, OR EACH ADDITIONAL 1% OF BODY AREA OF INFANTS AND CHILDREN, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
CPT/HCPC:15275
DESCRIPTION:APPLICATION OF SKIN SUBSTITUTE GRAFT TO FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET, AND/OR MULTIPLE DIGITS, TOTAL WOUND SURFACE AREA UP TO 100 SQ CM; FIRST 25 SQ CM OR LESS WOUND SURFACE AREA
CPT/HCPC: 15276
DESCRIPTION:APPLICATION OF SKIN SUBSTITUTE GRAFT TO FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET, AND/OR MULTIPLE DIGITS, TOTAL WOUND SURFACE AREA UP TO 100 SQ CM; EACH ADDITIONAL 25 SQ CM WOUND SURFACE AREA, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
CPT/HCPC:15277
DESCRIPTION:APPLICATION OF SKIN SUBSTITUTE GRAFT TO FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET, AND/OR MULTIPLE DIGITS, TOTAL WOUND SURFACE AREA GREATER THAN OR EQUAL TO 100 SQ CM; FIRST 100 SQ CM WOUND SURFACE AREA, OR 1% OF BODY AREA OF INFANTS AND CHILDREN
CPT/HCPC:15278
DESCRIPTION:APPLICATION OF SKIN SUBSTITUTE GRAFT TO FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET, AND/OR MULTIPLE DIGITS, TOTAL WOUND SURFACE AREA GREATER THAN OR EQUAL TO 100 SQ CM; EACH ADDITIONAL 100 SQ CM WOUND SURFACE AREA, OR PART THEREOF, OR EACH ADDITIONAL 1% OF BODY AREA OF INFANTS AND CHILDREN, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
Due to the CPT/HCPC deletion and new code additions the section "Indications and Limitations of Coverage and/or Medical Necessity" narrative as been revised to accommodate the changes.
Note the application procedures are used in both the covered and non-covered products. If the application procedure is used in applying a non-covered product considered a "wound dressing" it should be bill as non-covered.
Immune Globulin, Intravenous (IVIg)
Deleted CPT/HCPC
CPT/HCPC: C9270
DESCRIPTION:INJECTION, IMMUNE GLOBULIN (GAMMAPLEX), INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), 500 MG
CPT/HCPC:J1572
DESCRIPTION:INJECTION, IMMUNE GLOBULIN, (FLEBOGAMMA/FLEBOGAMMA DIF), INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), 500 MG
Lumbar Facet Blockade
Deleted CPT/HCPC
CPT/HCPC:64622
DESCRIPTION:DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE; LUMBAR OR SACRAL, SINGLE LEVEL
CPT/HCPC:64623
DESCRIPTION:DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE; LUMBAR OR SACRAL, EACH ADDITIONAL LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
New CPT/HCPC
CPT/HCPC:64635
DESCRIPTION:DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE(S), WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT); LUMBAR OR SACRAL, SINGLE FACET JOINT
CPT/HCPC:64636
DESCRIPTION:DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE(S), WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT); LUMBAR OR SACRAL, EACH ADDITIONAL FACET JOINT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
Non-Covered Services
Deleted CPT/HCPC
CPT/HCPC:0155T
DESCRIPTION: LAPAROSCOPY, SURGICAL; IMPLANTATION OR REPLACEMENT OF GASTRIC STIMULATION ELECTRODES, LESSER CURVATURE (IE, MORBID OBESITY)
Group: Group 2- components of another service [such as evaluation and management] or statutory, regulatory r rule coverage exclusions (i.e., the application of the Social Security Act [the statute] and/or CMS directives excludes the services from payment)
CPT/HCPC:0157T
DESCRIPTION:LAPAROTOMY, IMPLANTATION OR REPLACEMENT OF GASTRIC STIMULATION ELECTRODES, LESSER CURVATURE (IE, MORBID OBESITY)
Group: Group 2- components of another service [such as evaluation and management] or statutory, regulatory r rule coverage exclusions (i.e., the application of the Social Security Act [the statute] and/or CMS directives excludes the services from payment)
CPT/HCPC:0166T
DESCRIPTION:TRANSMYOCARDIAL TRANSCATHETER CLOSURE OF VENTRICULAR SEPTAL DEFECT, WITH IMPLANT; WITHOUT CARDIOPULMONARY BYPASS
Group: Group 1-not reasonable & necessary: inadequate evidence of efficacy and/or effectiveness
CPT/HCPC:0167T
DESCRIPTION:TRANSMYOCARDIAL TRANSCATHETER CLOSURE OF VENTRICULAR SEPTAL DEFECT, WITH IMPLANT; WITH CARDIOPULMONARY BYPASS
Group: Group 1-not reasonable & necessary: inadequate evidence of efficacy and/or effectiveness
CPT/HCPC: 0168T
DESCRIPTION:RHINOPHOTOTHERAPY, INTRANASAL APPLICATION OF ULTRAVIOLET AND VISIBLE LIGHT, BILATERAL
Group : Group 1-not reasonable & necessary: inadequate evidence of efficacy and/or effectiveness
How to access LCDs:
Navigate to the NAS website at: www.noridianmedicare.com
Hover over "Medicare Part A" and select the appropriate state
The End User Agreement for Providers will appear if you have not recently visited the website. Select "Accept" (if necessary)
Hover over "LCDs/Coverage/MR", hover over "Local Coverage Determinations (LCDs)" and select "Future Effective LCDs" (The results on this page include only future effective LCDs.) Note: after January 1, 2012 the LCDs will relocate to the "Active LCD" webpage.
Select appropriate state (This will redirect from the NAS website to the Medicare Coverage Database (MCD) on the CMS website.)
Select the LCD of interest
History:
01/23/2012 updated to add MN in the title.
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