Medicare Contractor: Palmetto GBA
Contact Information
Contractor Type
A and B MAC
Contractor Information
| Contractor Number: | 10111 |
| Business Name: | Palmetto GBA |
| Status: | A |
| Oversight Region: | Region I
|
| States: | AL - Alabama
|
Active LCDs:
ICD-10 L33423: Cardiac Computed Tomography & Angiography (CCTA) ICD-10 L33428: Cosmetic and Reconstructive Surgery ICD-10 L33445: Removal of Benign and Malignant Skin Lesions ICD-10 L33456: Total Joint Arthroplasty ICD-10 L33457: Cardiac Radionuclide Imaging ICD-10 L33459: Computerized Axial Tomography (CT), Thorax ICD-10 L33467: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography ICD-10 L34410: B-type Natriuretic Peptide (BNP) Testing ICD-10 L34411: Blepharoplasty, Eyelid Surgery, and Brow Lift ICD-10 L34412: Cardiac Rehabilitation ICD-10 L34413: Cataract Surgery ICD-10 L34415: CT of the Abdomen and Pelvis ICD-10 L34417: CT of the Head ICD-10 L34419: Homocysteine Level, Serum ICD-10 L34422: Infrared Coagulation (IRC) of Hemorrhoids ICD-10 L34424: Magnetic Resonance Angiography ICD-10 L34425: Magnetic Resonance Imaging of the Orbit, Face, and/or Neck ICD-10 L34426: Ophthalmic Angiography (Fluorescein and Indocyanine Green) ICD-10 L34427: Outpatient Occupational Therapy ICD-10 L34428: Outpatient Physical Therapy ICD-10 L34429: Outpatient Speech Language Pathology ICD-10 L34430: Respiratory Therapy (Respiratory Care) ICD-10 L34431: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI) ICD-10 L34433: Somatosensory Testing ICD-10 L34434: Upper Gastrointestinal Endoscopy and Visualization ICD-10 L34454: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy ICD-10 L34512: Corneal Pachymetry ICD-10 L34549: Ambulance Services ICD-10 L34551: One Day Stays for Chest Pain ICD-10 L34552: Outpatient Observation Bed/Room Services ICD-10 L34553: Stretta Procedure ICD-10 L34554: In Vitro Chemosensitivity & Chemoresistance Assays ICD-10 L34555: Non-Covered Category III CPT Codes ICD-10 L34570: Psychiatric Inpatient Hospitalization ICD-10 L34573: Cardiac Event Detection ICD-10 L34574: Dental Services ICD-10 L34575: Frequency of Dialysis ICD-10 L34576: Laparoscopic Sleeve Gastrectomy for Severe Obesity ICD-10 L34577: Retroperitoneal Ultrasound ICD-10 L34578: Surface Electrical Stimulation in the Treatment of Dysphagia ICD-10 L34580: Intravenous Immunoglobulin (IVIG) ICD-10 L35024: MolDX: Genetic Testing for Lynch Syndrome ICD-10 L35025: MolDX: Molecular Diagnostic Tests (MDT) ICD-10 L35026: Rituximab (Rituxan®) ICD-10 L35048: Nerve Conduction Studies and Electromyography ICD-10 L35071: MolDX: Circulating Tumor Cell Marker Assays ICD-10 L35072: MolDX: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing ICD-10 L35073: MolDX: NRAS Genetic Testing ICD-10 L35631: MolDX: Breast Cancer Index℠ Genetic Assay ICD-10 L35632: MolDX: ConfirmMDx Epigenetic Molecular Assay ICD-10 L35633: MolDX: GeneSight® Assay for Refractory Depression ICD-10 L35677: Infliximab ICD-10 L35724: Lab: Controlled Substance Monitoring and Drugs of Abuse Testing ICD-10 L35868: MolDX: Decipher® Prostate Cancer Classifier Assay ICD-10 L35869: MolDX: Prolaris™ Prostate Cancer Genomic Assay ICD-10 L35922: Lab: Special Histochemical Stains and Immunohistochemical Stains ICD-10 L35974: MolDX: MGMT Promoter Methylation Analysis ICD-10 L36033: MolDX: HLA-B*15:02 Genetic Testing ICD-10 L36044: MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease ICD-10 L36074: MolDX: Molecular RBC Phenotyping ICD-10 L36082: MolDX: BRCA1 and BRCA2 Genetic Testing ICD-10 L36089: MolDX: Genetic Testing for Hypercoagulability / Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR) ICD-10 L36109: Minimally Invasive Treatment for Benign Prostatic Hyperplasia Involving Prostatic Urethral Lift (Urolift®) ICD-10 L36125: MolDX: Breast Cancer Assay: Prosigna ICD-10 L36129: MolDX: Biomarkers in Cardiovascular Risk Assessment ICD-10 L36153: MolDX: Genomic Health™ Oncotype DX® Prostate Cancer Assay ICD-10 L36427: Wireless Capsule Endoscopy ICD-10 L36464: MolDX: HLA-DQB1*06:02 Testing for Narcolepsy ICD-10 L36471: Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy ICD-10 L36593: Polysomnography ICD-10 L36665: MolDX: ProMark Risk Score ICD-10 L36761: GlycoMark Testing for Glycemic Control ICD-10 L36763: MolDX: 4Kscore Assay ICD-10 L36827: MolDX: APC and MUTYH Gene Testing ICD-10 L36854: MolDX: Percepta© Bronchial Genomic Classifier ICD-10 L36912: MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health™) ICD-10 L36954: Noncovered Services other than CPT® Category III Noncovered Services ICD-10 L37022: Lab: Coenzyme Q10 (CoQ10) ICD-10 L37031: MolDX: BDX-XL2 ICD-10 L37043: MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease ICD-10 L37176: White Cell Colony Stimulating Factors ICD-10 L37260: MolDX: Prometheus IBD sgi Diagnostic Policy ICD-10 L37266: MolDX: AlloSure® Donor-Derived Cell-Free DNA Test ICD-10 L37531: Micro-Invasive Glaucoma Surgery (MIGS) ICD-10 L37581: MolDX: Cystatin C Measurement ICD-10 L37612: MolDX: Corus® CAD Assay ICD-10 L37632: Spinal Cord Stimulators for Chronic Pain ICD-10 L37633: Partial Hospitalization Programs ICD-10 L37638: Health and Behavior Assessment/Intervention ICD-10 L37641: Continuous Peripheral Nerve Blocks (CPNB) ICD-10 L37642: Nerve Blocks and Electrostimulation for Peripheral Neuropathy ICD-10 L37643: Routine Foot Care ICD-10 L37644: YAG Capsulotomy ICD-10 L37701: MolDX: Oncotype DX AR-V7 Nucleus Detect for Men with Metastatic Castrate Resistant Prostate Cancer (MCRPC) ICD-10 L37709: Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification (NAATs) ICD-10 L37713: MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels ICD-10 L37725: MolDX: DecisionDx-Melanoma ICD-10 L37761: Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Essential Tremor ICD-10 L37774: Supervised Exercise Therapy for the Treatment of Peripheral Arterial Disease with Symptomatic Lower Extremity Intermittent Claudication ICD-10 L37779: Intraoperative Radiation TherapyRetired LCDs:
ICD-10 L33433: Infectious Disease Molecular Diagnostic Testing ICD-10 L34416: Computerized Axial Tomography of the Chest/Thorax ICD-10 L36143: MolDX: NSCLC, Comprehensive Genomic Profile Testing ICD-10 L36483: MolDX: Chromosome 1p/19q Deletion Analysis ICD-10 L37639: Noninvasive Peripheral Arterial and Venous Studies ICD-10 L37640: Intensity Modulated Radiation Therapy (IMRT)Draft LCDs:
ICD-10 L37580: MolDX: Cystatin C Measurement ICD-10 L37582: GlycoMark Testing for Glycemic Control ICD-10 L37583: MolDX: ProMark Risk Score ICD-10 L37584: MolDX: Breast Cancer Index? Genetic Assay ICD-10 L37585: MolDX: ConfirmMDx Epigenetic Molecular Assay ICD-10 L37588: MolDX: Decipher® Prostate Cancer Classifier Assay ICD-10 L37589: MolDX: Prolaris™ Prostate Cancer Genomic Assay ICD-10 L37590: In Vitro Chemosensitivity & Chemoresistance Assays ICD-10 L37591: Helicobacter Pylori Infection Testing ICD-10 L37601: MolDX: MDS FISH ICD-10 L37611: MolDX: Corus® CAD Assay ICD-10 L37698: MolDX: Guardant360® Plasma-Based Comprehensive Genomic Profiling in Non-Small Cell Lung Cancer (NSCLC) ICD-10 L37700: MolDX: Oncotype DX AR-V7 Nucleus Detect for Men with Metastatic Castrate Resistant Prostate Cancer (MCRPC) ICD-10 L37708: MolDX: Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification (NAATs) ICD-10 L37712: MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels ICD-10 L37714: MolDX: Pigmented Lesion Assay (PLA) ICD-10 L37718: MolDX: Comprehensive Genomic Profiling to Guide Treatment in Patients with Metastatic Colorectal Cancer ICD-10 L37720: MolDX: Comprehensive Genomic Profiling to Guide Treatment in Patients with Metastatic Melanoma ICD-10 L37722: MolDX: Comprehensive Genomic Profiling to Guide Treatment in Patients with Advanced Primary Peritoneal, Fallopian Tube and Ovarian Cancer ICD-10 L37724: MolDX: DecisionDx-Melanoma ICD-10 L37760: Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Essential Tremor ICD-10 L37773: Supervised Exercise Therapy for the Treatment of Peripheral Arterial Disease with Symptomatic Lower Extremity Intermittent Claudication ICD-10 L37778: Intraoperative Radiation Therapy ICD-10 L37793: MolDX: Breast Cancer IndexTM (BCI) Gene Expression Test ICD-10 L37825: Lumbar Artificial Disc Replacement ICD-10 L37847: Lumbar Spinal Fusion ICD-10 L37849: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy ICD-10 L37852: Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies ICD-10 L37856: MolDX: Envisia, Veracyte, Idiopathic Pulmonary Fibrosis Diagnostic Test ICD-10 L37858: MolDX: myPath Melanoma Assay ICD-10 L37862: Voretigene Neparvovec-rzyl (Luxturna™) ICD-10 L37864: MolDX: NeuroIDgenetix® Test for Depression ICD-10 L37869: MolDX: Inivata, InVisionFirst, Liquid Biopsy for Patients with Lung Cancer ICD-10 L37872: Topical Oxygen Therapy
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