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UB04 Condition Codes
UB04 Revenue Codes
Notice: It is not appropriate to bill Medicare for services that are not covered (as described by this entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier (see "Coding Guidelines" section in the attached article for instructions).
Cardiac Event Detection involves the use of a long-term monitor by patients to document a suspected or paroxysmal dysrhythmia. Following the recording of events, the patient transmits data via telephone to a physician's office or a specified station that is equipped and staffed to assess electrocardiographic data and to initiate appropriate management action. The device must be patient-activated.
The CPT/HCPCS codes that follow have two key distinguishing features:
This LCD supplements but does not replace, modify or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for cardiac event detection services. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. They are not repeated in this LCD. Neither Medicare payment policy rules nor this LCD replace, modify or supersede applicable state statutes regarding medical practice or other health practice professions acts, definitions and/or scopes of practice. All providers who report services for Medicare payment must fully understand and follow all existing laws, regulations and rules for Medicare payment for cardiac event detection services and must properly submit only valid claims for them. Please review and understand them and apply the medical necessity provisions in the policy within the context of the manual rules. Relevant CMS manual instructions and policies regarding cardiac event detection services are found in the following Internet-Only Manuals (IOMs) published on the CMS Web site:
- Medicare Benefit Policy Manual - Pub. 100-02.
- Medicare National Coverage Determinations Manual - Pub. 100-03.
- Correct Coding Initiative - Medicare Contractor Beneficiary and Provider Communications Manual - Pub. 100-09, Chapter 5.
- Social Security Act (Title XVIII) Standard References, Sections:
- 1862(a)(1)(A) Medically Reasonable & Necessary.
- 1862(a)(1)(D) Investigational or Experimental.
- 1833(e) Incomplete Claim.
Contractor Name(Contractor Number) - Contractor Info
10/29/2012: In accordance with Section 911 of the Medicare Modernization Act (MMA) of 2003 and Change Request (CR) 7812, the following contract numbers were removed for this LCD: 04101, 04201, 04301, 04401, and 04901. These contract numbers were removed due to the transition of the covered states from TrailBlazer Health Enterprises to Novitas, the Jurisdiction H Centers for Medicare & Medicaid Services (CMS) Medicare contractor. No other changes were made.
10/29/2012 - In accordance with Section 911 of the Medicare Modernization Act (MMA) of 2003 and CMS Change Request (CR) 7812, the following contract numbers were removed from this LCD: 04101, 04201, 04301, 04401, and 04901.
These contract numbers were removed due to the transition of the covered states from TrailBlazer Health Enterprises to Novitas-Solutions, the Jurisdiction H CMS Medicare contractor. No other changes were made.
Per CR 7228, notice of automatic denial for claim line items with a GZ modifier added to definition of GZ modifier in "Coding Guidelines" section of related article. Effective date: 07/01/2011.
Per CR 7121 (annual HCPCS update), description changed for the GA modifier. Effective date: 01/01/2011.
Per CR 7121 (annual HCPCS update), deleted CPT codes 93012 and 93014. Effective date: 12/31/2010.
Use of LCD and related article made applicable to providers transitioning from WPS to TrailBlazer with addition of contractor number 04901. Effective date: dates of service on or after 10/18/2010.
Per CR 6338, added end date of 03/31/2010 for TOB code 73X (no longer to be used for Medicare billing) and added TOB code 77X for use with dates of service on or after 04/01/2010 when billing for services rendered in a freestanding FQHC or a provider-based FQHC in the "Type of Bill Codes" section of the LCD and related article. Effective date: 01/04/2010.
Identified CPT codes 93014, 93268 and 93270 as Non-OPPS only codes in the LCD and Article sections titled "CPT HCPCS Codes" and in the Article section titled "Coding Guidelines." Effective dates: 03/01/2008 for Oklahoma (Part A and Part B) and New Mexico (Part B); 03/21/2008 for Colorado (Part B); and 06/13/2008 for Colorado (Part A), New Mexico (Part A) and Texas (Part A and Part B).
LCD effective in TX Part A and Part B and Part A CO and NM 06/13/2008.
Moved E942.0, E942.1 and E942.9 out of the section titled "ICD-9-CM Codes That Support Medical Necessity", and moved to the section titled "Diagnoses that Support Medical Necessity". This change does not affect coverage. Effective for each state based on cutover date.
LCD effective in CO Part B 03/21/2008.
LCD effective in NM Part B and OK Part A and Part B 03/01/2008.
12/20/2007 Consolidated LCD posted for notice effective: 12/20/2007
11/21/2011 - For the following CPT/HCPCS codes either the short description and/or the long description was changed. Depending on which description is used in this LCD, there may not be any change in how the code displays in the document:
93271 descriptor was changed in Group 1
11/18/2012: In accordance with Secion 911 of the Medicare Modernization Act (MMA) of 2003 and Change Request (CR) 7812, this LCD is being retired.
J4 (CO, NM, OK, TX) MAC Integration
TrailBlazer Health Enterprises, LLC adopted the Noridian Administrative Services, LLC LCD, "Cardiac Event Detection Policy," for Jurisdiction 4 (J4) MAC transition.
Full disclosure of sources of information is found with original contractor LCD.
Other Contractor Local Coverage Determinations
"Cardiac Event Detection Monitoring," TrailBlazer LCD, (00400) L16986, (00900) L17010.
"Cardiac Event Detection (CED) Policy," Noridian Administrative Services, LLC LCD, (CO) L23703.
"Transtelephonic Electrocardiographic Transmission / Monitoring," Arkansas BlueCross BlueShield (Pinnacle) LCD, (NM and OK) L9464, L11847.
"Patient-Activated EKG Recorders," Arkansas BlueCross BlueShield (Pinnacle) LCD, (NM and OK) L9386, L11805.
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.12 - Hospital Inpatient (Medicare Part B only)
13 - Hospital Outpatient
18 - Hospital - Swing Beds
21 - Skilled Nursing - Inpatient (Including Medicare Part A)
22 - Skilled Nursing - Inpatient (Medicare Part B only)
23 - Skilled Nursing - Outpatient
71 - Clinic - Rural Health
73 - Clinic - Freestanding
75 - Clinic - Comprehensive Outpatient Rehabilitation Facility (CORF)
77 - Clinic - Federally Qualified Health Center (FQHC)
85 - Critical Access Hospital
Bill Type Note (above): Code 73X end-dated for Medicare use March 31, 2010; code 77X effective for dates of service on or after April 1, 2010.0730 - EKG/ECG (Electrocardiogram) - General Classification
Note: TrailBlazer has identified the Bill Type and Revenue Codes applicable for use with the CPT/HCPCS codes included in this LCD. Providers are reminded that not all CPT/HCPCS codes listed can be billed with all Bill Type and/or Revenue Codes listed. CPT/HCPCS codes are required to be billed with specific Bill Type and Revenue Codes. Providers are encouraged to refer to the CMS Internet-Only Manual (IOM) Pub. 100-04, Claims Processing Manual, for further guidance.
0731 - EKG/ECG (Electrocardiogram) - Holter Monitor
0732 - EKG/ECG (Electrocardiogram) - Telemetry
0739 - EKG/ECG (Electrocardiogram) - Other EKG/ECG
Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book. The American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) require the use of short CPT descriptors in policies published on the Web.
93014, 93268, 93270 (Non-OPPS only)
93268 93270 93271 93272
Note: Providers should continue to submit ICD-9-CM diagnosis codes without decimals on their claim forms and electronic claims.
The CPT/HCPCS codes included in this LCD will be subjected to "procedure to diagnosis" editing. The following lists include only those diagnoses for which the identified CPT/HCPCS procedures are covered. If a covered diagnosis is not on the claim, the edit will automatically deny the service as not medically necessary.
Medicare is establishing the following limited coverage for CPT/HCPCS codes 93268, 93270, 93271 and 93272:
414.2 426.0 426.10 426.11 426.12 426.13 426.6 426.7 426.81 426.82 426.89 426.9 427.0 427.1 427.2 427.31 427.32 427.41 427.42 427.5 427.60 427.61 427.69 427.81 427.89 435.9 780.2 780.4 785.0 785.1 786.09 V12.53 V67.51
Note: Use of these "E" codes will provide further clarification of the need for the procedure, but does not affect coverage.
The following "E" codes may be used as a secondary diagnosis when other covered ICD-9-CM diagnosis codes are used as the primary diagnosis.
E942.0 Cardiac rhythm regulators causing adverse effects in therapeutic use
E942.1 Cardiotonic glycosides and drugs of similar action causing adverse effects in therapeutic use
E942.9 Other and unspecified agents primarily affecting the cardiovascular system causing adverse effects in therapeutic use
Medicare Policies and Guidelines - NCD, LCD, Articles, LMRP
Summary: Medicare Policies and Guidelines - NCD, LCD, Articles, LMRP
Keywords: Medicare Policies and Guidelines, NCD, LCD, LMRP, national coverage determinations, local coverage determinations, local medical review policies
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