CPT® Procedure Codes
HCPCS Supply/DME Codes
ICD-9-CM Diagnosis Codes
DRGs & APCs
ICD-10-CM Diagnosis Codes
ICD-10-PCS Procedure Codes
Place of Service Codes
UB04 Condition Codes
UB04 Revenue Codes
Compliance with the provisions in this policy may be monitored and addressed through post payment data analysis and subsequent medical review audits.
Ultrasound of the extremity is a non-invasive imaging technique that uses high-frequency sound waves to evaluate the extremities (arms and legs including shoulders, hips, hands and feet), providing real-time, two-dimensional images. Longitudinal, transverse and oblique images of the area of interest are obtained. Ultrasound, echography and sonography are all terms that may be used interchangeably to describe this particular imaging technique.
Ultrasound may be considered medically reasonable and necessary when used for guidance during a procedure.
This LCD identifies the indications and limitations of Medicare coverage for ultrasound guidance utilized during an aspiration or injection procedure of an extremity.
Extremity ultrasound guidance may be considered medically reasonable and necessary for the following:
Title XVIII of the Social Security Act, Section 1862(a)(1)(A) states that no Medicare payment shall be made for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury.
Title XVIII of the Social Security Act, Section 1862(a)(7). This section excludes routine physical examinations.
Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider for any claim that lacks the necessary information to process the claim.
CMS Internet-Only Manual (IOM) Publication 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Section 220. 5, Ultrasound Diagnostic Procedures
CMS Internet-Only Manual (IOM) Publication 100-04, Medicare Claims Processing Manual, Chapter 7, Section 50, Billing Part B Radiology Services and Other Diagnostic Procedures
CMS Internet-Only Manual (IOM) Publication 100-04, Medicare Claims Processing Manual, Chapter 12, Section 70, Payment Conditions for Radiology Services
CMS Internet-Only Manual (IOM) Publication 100-04, Medicare Claims Processing Manual, Chapter 13, Section 10.1, Billing Part B Radiology Services and Other Diagnostic Procedures
- All documentation must be maintained in the patient’s medical record and available to the contractor upon request.
- Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service(s)). The record must include the physician or non-physician practitioner responsible for and providing the care of the patient.
- The submitted medical record should support the use of the selected ICD-9-CM code(s). The submitted CPT/HCPCS code should describe the service performed.
- In cases where morbid obesity is claimed for a reason for guidance in injection/aspiration of the hip or knee, the length of the needle used in the failed initial attempt at the procedure must be kept on file in the record of the provider performing the procedure.
- A permanent record of the ultrasound and its interpretation should be kept on file in the patient's record. The record should include all of the following:
- Images of all appropriate areas, labeled with exam date, patient identification, and image orientation; and
- documentation of the variations from normal, accompanied by measurements;
- formal interpretation.
- Results of all testing should be shared with the referring physician.
Please also refer to LCD L30271 Non-Vascular Extremity Ultrasound for additional information.
In accordance with CMS Ruling 95-1 (V), utilization of these services should be consistent with locally acceptable standards of practice.
Utilization of this service will be evaluated on a postpayment basis. Providers who exceed their peer group may be subject to periodic review to ensure compliance with this policy.
Contractor Name(Contractor Number) - Contractor Info
02/21/2011 - Per Change Request 7135, providers in the states of Delaware, Maryland, New Jersey, Pennsylvania and the District of Columbia serviced by Wisconsin Physicians Service (WPS), contractor number 52280, are being transitioned to Highmark Medicare Services, contractor number 12901, effective 02/21/2011. Effective 02/21/2011, contractor number 12901 has been added to this draft LCD.
01/25/2011 DL31683 Draft LCD posted for comment.
Highmark Medicare Services is not responsible for the continued viability of websites listed.
Balint P, Kane D, Hunter J, et al. Ultrasound Guided Versus Conventional Joint Soft Tissue Fluid Aspiration in Rheumatology Practice: A Pilot Study. J Rheumatol 2002;29(10):2209-2213.
Balint PV, Kane D, Wilson H, et al. Ultrasonography of entheseal insertions in the lower limb in spondyloarthropathy: Ann Rheum Dis 2002;61:905-910.
Delle Sedie A, Riente L, Bombardieri S. Limits and perspectives of ultrasound in the diagnosis and management of rheumatic diseases: Mod Rheumatol (2008) 18:125-131 DOI 10.1007/s10165-008-0046-z.
Eustace JA, Brophy P, Gibney RP, et al. Comparison of the accuracy of steroid placement with clinical outcome in patients with shoulder symptoms. Annals of the Rheumatic Diseases 1997;56:59-63.
Im SH, Lee SC, Park YB, et al. Feasibility of Sonography for Intra-articular Injections in the Knee Through a Medial Patellar Portal. American Institute of Ultrasound in Medicine. JUltrasound Med 2009;28:1465-1470.
Jackson DW, Evans NA, Thomas BM. Accuracy of Needle Replacement into the Intra-Articular Space of the Knee. The Journal of Bone and Joint Surgery 2002;84-A(9):1522-1527.
Kane D, Balint PV, Sturrick R, Grassi W. Musculoskeletal ultrasound - a state of the art review in rheumatology. Part 1: Current controversies and issues in the development of musculoskeletal ultrasound in rheumatology. Rheumatology 2004:43-:823-828. Advance Access publication 11 May 2004. doi:10.1093/rheumatology/keh214.
Koski JM. Ultrasound Guided Injections in Rheumatology. J Rheumatol 2000;27(9):2131-8.
Lin JT, Adler RS, Bracilovic A, et al. Clinical Outcomes of Ultrasound-Guided Aspiration and Lavage in Calcific Tendinosis of the Shoulder. HSSJ 2006;3:99-105.
Martinoli C, Bianchi S, Dahmane M, et al. Ultrasound of tendons and nerves. Eur Radiol 2002 Jan;12 (1):44-55. Epub 2001 Oct 19.
McShane JM, Nazarian LN, Harwood MI. Sonographically Guided Percutaneous Needle Tenotomy for Treatment of Common Extensor Tendinosis in the Elbow. J Ultrasound Med 2006;25(10):1281-9.
Meenagh G, Filipucci E, Delle Sedie A, et al. Ultrasound Imaging for the Rheumatologist XIX: Imaging Modalities in Rheumatoid Arthritis. Clin Exp Rheumatol 2009; 27:3-6.
Meenagh G, Filipucci E, Delle Sedie A, et al. Ultrasound Imaging for the Rheumatologist XVIII: Ultrasound Measurements. Clin Exp Rheumatol 2008; 26:982-985.
Naredo E, Cabero F, Beneyto P, et al. A Randomized Comparative Study of Short Term Response to Blind Injection versus Sonographic-Guided Injection of Local Corticosteroids in Patients with Painful Shoulder. J Rheumatol 2004;31(2):308-14.
Parker L, Nazarian LN, et al. Musculoskeletal Imaging: Medicare Use, Costs, and Potential for Cost Substitution. Journal of the American College of Radiology 2008; 5 (3):182-188.
Sibbitt WL, Peisajovich A, Michael AA, et al. Does Sonographic Needle Guidance Affect the Clinical Outcome of Intraarticular Injections? The Journal of Rheumatology 2009;36:1892-1902.
Other Contractor(s)' Policies
Highmark Medicare Services Contractor Medical Directors
This policy does not reflect the sole opinion of the contractor or Contractor Medical Directors. Although the final decision rests with the contractor, this policy was developed in cooperation with advisory groups, which includes representatives from the appropriate specialty (ies).
CAC Distribution: 01/25/2011
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.11 - Hospital Inpatient (Including Medicare Part A)
12 - Hospital Inpatient (Medicare Part B only)
13 - Hospital Outpatient
71 - Clinic - Rural Health
73 - Clinic - Freestanding
83 - Ambulatory Surgery Center
85 - Critical Access Hospital
0402 - Other Imaging Services - Ultrasound
0972 - Professional Fees - Radiology - Diagnostic
Italicized and/or quoted material is excerpted from the American Medical Association, Current Procedural Terminology (CPT) codes. 76942
It is the provider's responsibility to select codes carried out to the highest level of specificity and selected from the ICD-9-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.
Procedure code 76942 is representative of more services than what are addressed in this LCD, therefore, the following ICD-9-CM codes will be applied on a post-payment basis:
715.15 715.16 715.25 715.26 715.35 715.36 719.04 719.05 719.06 719.07 727.40 727.41 727.42 727.51
Conditions that are listed in the "ICD-9 Codes that Support Medical Necessity" section of this policy.
All those not listed under the "ICD-9 Codes that Support Medical Necessity" section of this policy.
Conditions that are not listed in the "ICD-9 Codes that Support Medical Necessity" section of this policy.
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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