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YMS R19 Med Policies

Policy Documents

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Policies
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Multiple documents Icon (FDG) PET for Brain, Cervical, Ovarian, Pancreatic, Small Cell Lung, and Testicular Cancers - 220.6.14
NCD
Multiple documents Icon (FDG) PET for Colorectal Cancer - 220.6.4
NCD
Multiple documents Icon 24-Hour Ambulatory Esophageal pH Monitoring - 100.3
NCD
Multiple documents Icon 3D Interpretation and Reporting of Imaging Studies [L30729, rev. 1]
Part B
Multiple documents Icon Abarelix for the Treatment of Prostate Cancer - 110.19
NCD
Multiple documents Icon Ablative Therapy [L30312, rev. 12]
Part B
Multiple documents Icon Abortion - 140.1
NCD
Multiple documents Icon Acupuncture - 30.3
NCD
Multiple documents Icon Acupuncture for Fibromyalgia - 30.3.1
NCD
Multiple documents Icon Acupuncture for Osteoarthritis - 30.3.2
NCD
Multiple documents Icon Adult Liver Transplantation - 260.1
NCD
Multiple documents Icon Air-Fluidized Bed - 280.8
NCD
Multiple documents Icon Allergy Testing and Allergy Immunotherapy [L30471, rev. ]
Part B
Multiple documents Icon Alpha-fetoprotein (AFP) - 190.25
NCD
Multiple documents Icon Ambulatory Blood Pressure Monitoring - 20.19
NCD
Multiple documents Icon Ambulatory EEG Monitoring - 160.22
NCD
Multiple documents Icon Anesthesia in Cardiac Pacemaker Surgery - 10.6
NCD
Multiple documents Icon Ankle-Foot/Knee-Ankle-Foot Orthosis [L142, rev. AFO0013]
DME MAC
Multiple documents Icon Anti-Cancer Chemotherapy for Colorectal Cancer - 110.17
NCD
Multiple documents Icon Anti-Inhibitor Coagulant Complex (AICC) - 110.3
NCD
Multiple documents Icon Antigens Prepared for Sublingual Administration - 110.9
NCD
Multiple documents Icon Apheresis (Therapeutic Pheresis) - 110.14
NCD
Multiple documents Icon Application of Bioengineered Skin Substitutes [L30135, rev. R5]
Part B
Multiple documents Icon Application of Bioengineered Skin Substitutes: Ulcers of the Lower Extremities [L21279, rev. R12]
Part A
Multiple documents Icon Aprepitant for Chemotherapy-Induced Emesis - 110.18
NCD
Multiple documents Icon Arthroscopic Lavage and Arthroscopic Debridement for the Osteoarthritic Knee - 150.9
NCD
Multiple documents Icon Artificial Hearts and Related Devices - 20.9
NCD
Multiple documents Icon Assessing Patient's Suitability for Electrical Nerve Stimulation Therapy - 160.7.1
NCD
Multiple documents Icon Autogenous Epidural Blood Graft - 10.5
NCD
Multiple documents Icon Automatic External Defibrillators [L13577, rev. AED005]
DME MAC
Multiple documents Icon B-type Natriuretic Peptide (BNP) Testing [L31193, rev. ]
Part A
Multiple documents Icon Bariatric Surgery for Treatment of Morbid Obesity - 100.1
NCD
Multiple documents Icon Biofeedback [L31070, rev. ]
Part B
Multiple documents Icon Biofeedback Therapy - 30.1
NCD
Multiple documents Icon Biofeedback Therapy for the Treatment of Urinary Incontinence - 30.1.1
NCD
Multiple documents Icon Bisphosphonate Drug Therapy [L30139, rev. R5]
Part B
Multiple documents Icon Bladder Stimulators (Pacemakers) - 230.16
NCD
Multiple documents Icon Blepharoplasty, Blepharoptosis and Brow Lift [L29973, rev. 5]
Part B
Multiple documents Icon Blood-Derived Products for Chronic Non-Healing Wounds - 270.3
NCD
Multiple documents Icon Blood Brain Barrier Osmotic Disruption for Treatment of Brain Tumors - 110.20
NCD
Multiple documents Icon Blood Counts - 190.15
NCD
Multiple documents Icon Blood Glucose Testing - 190.20
NCD
Multiple documents Icon Blood Platelet Transfusions - 110.8
NCD
Multiple documents Icon Blood Transfusions - 110.7
NCD
Multiple documents Icon Bone Mass Measurement [L31620, rev. ]
Part B
Multiple documents Icon Bone (Mineral) Density Studies - 150.3
NCD
Multiple documents Icon Botulinum Toxin Type A & Type B [L28555, rev. 11]
Part B
Multiple documents Icon Brachytherapy [L30320, rev. ]
Part B
Multiple documents Icon Breast Reconstruction Following Mastectomy - 140.2
NCD
Multiple documents Icon Canes and Crutches [L11485, rev. C&C006]
DME MAC
Multiple documents Icon Capsule Endoscopy [L30141, rev. ]
Part B
Multiple documents Icon Carcinoembryonic Antigen (CEA) - 190.26
NCD
Multiple documents Icon Cardiac Catheterization and Coronary Angiography [L30719, rev. ]
Part B
Multiple documents Icon Cardiac Catheterization Performed in Other than a Hospital Setting - 20.25
NCD
Multiple documents Icon Cardiac Output Monitoring by Thoracic Electrical Bioimpedance (TEB) - 20.16
NCD
Multiple documents Icon Cardiac Pacemaker Evaluation Services - 20.8.1
NCD
Multiple documents Icon Cardiac Pacemakers - 20.8
NCD
Multiple documents Icon Cardiac Rehabilitation Programs - 20.10
NCD
Multiple documents Icon Cardiointegram (CIG) as an Alternative to Stress Test or Thallium Stress Test - 20.27
NCD
Multiple documents Icon Cardiovascular Stress Testing [L28563, rev. R5]
Part B
Multiple documents Icon Carotid Body Resection/Carotid Body Denervation - 20.18
NCD
Multiple documents Icon Carotid Sinus Nerve Stimulator - 160.6
NCD
Multiple documents Icon Cataract Surgery and Complex Cataract Surgery [L30159, rev. ]
Part B
Multiple documents Icon CATEGORY III CPT CODES
MedicareBlue
Multiple documents Icon Cavernous Nerves by Electrical Stimulation with Penile Plethysmography - 160.26
NCD
Multiple documents Icon Cellular Therapy - 30.8
NCD
Multiple documents Icon Certain Drugs Distributed by the National Cancer Institute - 110.2
NCD
Multiple documents Icon Cervical Traction Devices [L15300, rev. CTD007]
DME MAC
Multiple documents Icon Challenge Ingestion Food Testing - 110.12
NCD
Multiple documents Icon Chelation Therapy for Treatment of Atherosclerosis - 20.21
NCD
Multiple documents Icon Chemical Aversion Therapy for Treatment of Alcoholism - 130.3
NCD
Multiple documents Icon Chemotherapy Drugs and their Adjuncts [L28576, rev. X]
Part B
Multiple documents Icon Chest X-Ray Policy [L19850, rev. R9]
Part A
Multiple documents Icon Chiropractic Services [L30328 , rev. R10]
Part B
Multiple documents Icon Closed-Loop Blood Glucose Control Device (CBGCD) - 40.3
NCD
Multiple documents Icon Cochlear Implantation - 50.3
NCD
Multiple documents Icon Cochleostomy with Neurovascular Transplant for Meniere's Disease - 50.7
NCD
Multiple documents Icon Cold Therapy [L11567, rev. COLD003]
DME MAC
Multiple documents Icon Collagen Crosslinks, any Method - 190.19
NCD
Multiple documents Icon Collagen Meniscus Implant - 150.12
NCD
Multiple documents Icon Colonic Irrigation - 100.7
NCD
Multiple documents Icon Colonoscopy and Sigmoidoscopy-Diagnostic [L30304, rev. R6]
Part B
Multiple documents Icon Colorectal Cancer Screening Tests - 210.3
NCD
Multiple documents Icon Commodes [L11486, rev. COM008]
DME MAC
Multiple documents Icon Computed Coronary Tomography Angiography [L30288, rev. R7]
Part B
Multiple documents Icon Computed Tomography - 220.1
NCD
Multiple documents Icon Computer Enhanced Perimetry - 80.9
NCD
Multiple documents Icon Computerized Corneal Topography [L31064, rev. N/A]
Part B
Multiple documents Icon Computerized Tomography (CAT Scans) [L28544, rev. R5]
Part B
Multiple documents Icon Consultation Services Rendered by a Podiatrist in a Skilled Nursing Facility - 70.2
NCD
Multiple documents Icon Consultations with a Beneficiary's Family and Associates - 70.1
NCD
Multiple documents Icon Continuous Positive Airway Pressure (CPAP) Therapy For Obstructive Sleep Apnea (OSA) - 240.4
NCD
Multiple documents Icon Corneal Pachymetry [L30485, rev. ]
Part B
Multiple documents Icon Corset Used as Hernia Support - 280.11
NCD
Multiple documents Icon Cosmetic and Reconstructive Surgery [L30733, rev. ]
Part B
Multiple documents Icon Counseling to Prevent Tobacco Use - 210.4.1
NCD
Multiple documents Icon Cranial Stereotactic Radiosurgery (SRS) and Cranial Stereotactic Radiotherapy (SRT) [L30318, rev. X]
Part B
Multiple documents Icon Cryosurgery of Prostate - 230.9
NCD
Multiple documents Icon CT Colonography [L26199, rev. R1]
Part A
Multiple documents Icon CT Colonography (Virtual Colonoscopy [VC]) [L30300, rev. ]
Part B
Multiple documents Icon Cytogenetic Studies [L30487, rev. ]
Part B
Multiple documents Icon Cytogenetic Studies - 190.3
NCD
Multiple documents Icon Cytotoxic Food Tests - 110.13
NCD
Multiple documents Icon Deep Brain Stimulation for Essential Tremor and Parkinson's Disease - 160.24
NCD
Multiple documents Icon Dental Examination Prior to Kidney Transplantation - 260.6
NCD
Multiple documents Icon Dental Services
MedicareBlue
Multiple documents Icon Dermal Injections for Treatment of Facial Lipodystrophy Syndrome (LDS) - 250.5
NCD
Multiple documents Icon Diabetes Outpatient Self-Management Training - 40.1
NCD
Multiple documents Icon Diagnosis and Treatment of Impotence - 230.4
NCD
Multiple documents Icon Diagnostic Breath Analyses - 100.5
NCD
Multiple documents Icon Diagnostic Endocardial Electrical Stimulation (Pacing) - 20.12
NCD
Multiple documents Icon Diagnostic Pap Smears - 190.2
NCD
Multiple documents Icon Diagnostic PAP Tests [L31080, rev. N/A]
Part B
Multiple documents Icon Dialysis Shunt Maintenance [L20052, rev. ]
Part B
Multiple documents Icon Diathermy Treatment - 150.5
NCD
Multiple documents Icon Digital Subtraction Angiography - 220.9
NCD
Multiple documents Icon Digoxin Therapeutic Drug Assay - 190.24
NCD
Multiple documents Icon Dimethyl Sulfoxide (DMSO) - 230.12
NCD
Multiple documents Icon Displacement Cardiography - 20.24
NCD
Multiple documents Icon Drugs and Biologics (Non-chemotherapy) [L32013, rev. ]
Part B
Multiple documents Icon Durable Medical Equipment Reference List - 280.1
NCD
Multiple documents Icon Electrical Aversion Therapy for Treatment of Alcoholism - 130.4
NCD
Multiple documents Icon Electrical Continence Aid - 230.15
NCD
Multiple documents Icon Electrical Nerve Stimulators - 160.7
NCD
Multiple documents Icon Electrical Stimulation (ES) and Electromagnetic Therapy for the Treatment of Wounds - 270.1
NCD
Multiple documents Icon Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring) [L29584, rev. ]
Part B
Multiple documents Icon Electrocardiographic (EKG) Services - 20.15
NCD
Multiple documents Icon Electroconvulsive Therapy (ECT) [L30493, rev. ]
Part B
Multiple documents Icon Electroencephalographic (EEG) Monitoring During Surgical Procedures Involving the Cerebral Vasculature - 160.8
NCD
Multiple documents Icon Electromagnetic Navigation Bronchoscopy (ENB) [L30510, rev. ]
Part B
Multiple documents Icon Electron Microscope - 190.4
NCD
Multiple documents Icon Electronecephalographic (EEG) Monitoring During Open-Heart Surgery - 160.9
NCD
Multiple documents Icon Electronic Speech Aids - 50.2
NCD
Multiple documents Icon Electrosleep Therapy - 30.4
NCD
Multiple documents Icon Electrotherapy for Treatment of Facial Nerve Paralysis (Bell's Palsy) - 160.15
NCD
Multiple documents Icon Endoscopic Treatment of GERD [L30473, rev. ]
Part B
Multiple documents Icon Endoscopy - 100.2
NCD
Multiple documents Icon Endothelial Cell Photography - 80.8
NCD
Multiple documents Icon Enteral and Parenteral Nutritional Therapy - 180.2
NCD
Multiple documents Icon Enteral Nutrition [L11568, rev. ENT010]
DME MAC
Multiple documents Icon Epidural and Transforaminal Epidural Injections [L30481, rev. ]
Part B
Multiple documents Icon Erythropoiesis Stimulating Agents Epotein alfa (EPO), Darbepotein alfa (DPA) [L31074, rev. N/A]
Part B
Multiple documents Icon Erythropoiesis Stimulating Agents (ESAs) [L26383, rev. R4]
Part A
Multiple documents Icon Erythropoiesis Stimulating Agents (ESAs) in Cancer and Related Neoplastic Conditions - 110.21
NCD
Multiple documents Icon Esophageal Manometry - 100.4
NCD
Multiple documents Icon Ethylenediamine-Tetra-Acetic (EDTA) Chelation Therapy for Treatment of Atherosclerosis - 20.22
NCD
Multiple documents Icon Evoked Response Tests - 160.10
NCD
Multiple documents Icon Exhaled Nitric Oxide
MedicareBlue
Multiple documents Icon External Breast Prostheses [L11569, rev. EBP009]
DME MAC
Multiple documents Icon External Counterpulsation (ECP) for Severe Angina - 20.20
NCD
Multiple documents Icon External Infusion Pumps [L11570, rev. EIP020]
DME MAC
Multiple documents Icon Extracorporeal Immunoadsorption (ECI) Using Protein A Columns - 20.5
NCD
Multiple documents Icon Extracorporeal Photopheresis - 110.4
NCD
Multiple documents Icon Extracranial-Intracranial (EC-IC) Arterial Bypass Surgery - 20.2
NCD
Multiple documents Icon Eye Prostheses [L194, rev. EYE003]
DME MAC
Multiple documents Icon Fabric Wrapping of Abdominal Aneurysms - 20.23
NCD
Multiple documents Icon Facial Prostheses [L11571, rev. FACE005]
DME MAC
Multiple documents Icon Fecal Occult Blood Test (FOBT) - 190.34
NCD
Multiple documents Icon Flow Cytometry [L30161, rev. ]
Part B
Multiple documents Icon Fluidized Therapy Dry Heat for Certain Musculoskeletal Disorders - 150.8
NCD
Multiple documents Icon Fluorescein or Indocyanine Green Angiography [L30727, rev. R1]
Part B
Multiple documents Icon Food Allergy Testing and Treatment - 110.11
NCD
Multiple documents Icon Gamma Glutamyl Transferase (GGT) - 190.32
NCD
Multiple documents Icon Gastric Balloon for Treatment of Obesity - 100.11
NCD
Multiple documents Icon Gastric Freezing - 100.6
NCD
Multiple documents Icon Gastrophotography - 100.12
NCD
Multiple documents Icon Glucose Monitors [L196, rev. GM013]
DME MAC
Multiple documents Icon Glycated Hemoglobin/Glycated Protein - 190.21
NCD
Multiple documents Icon Granulocyte Transfusions - 110.5
NCD
Multiple documents Icon Gravlee Jet Washer - 230.5
NCD
Multiple documents Icon Hair Analysis - 190.6
NCD
Multiple documents Icon Health and Behavior Assessment/Intervention [L30514, rev. ]
Part B
Multiple documents Icon Heart Transplants - 260.9
NCD
Multiple documents Icon Heartsbreath Test for Heart Transplant Rejection - 260.10
NCD
Multiple documents Icon Heat Treatment, including the Use of Diathermy and Ultrasound for Pulmonary Conditions - 240.3
NCD
Multiple documents Icon Heating Pads and Hear Lamps [L28484, rev. ]
DME MAC
Multiple documents Icon Heavy Metal Testing [L31067, rev. ]
Part B
Multiple documents Icon Helicobacter Pylori Testing [L30163, rev. X]
Part B
Multiple documents Icon Hemodialysis for Treatment of Schizophrenia - 130.8
NCD
Multiple documents Icon Hemophilia Clotting Factors [L31078, rev. ]
Part B
Multiple documents Icon Hemorheograph - 250.2
NCD
Multiple documents Icon Hepatitis Panel/Acute Hepatitis Panel - 190.33
NCD
Multiple documents Icon High Frequency Chest Wall Oscillation Devices [L12739, rev. HFCWO004]
DME MAC
Multiple documents Icon HIS Bundle Study - 20.13
NCD
Multiple documents Icon Histocompatibility Testing - 190.1
NCD
Multiple documents Icon Home Blood Glucose Monitors - 40.2
NCD
Multiple documents Icon Home Health Nurses' Visits to Patients Requiring Heparin Injection - 290.2
NCD
Multiple documents Icon Home Health Visits to a Blind Diabetic - 290.1
NCD
Multiple documents Icon Home Oxygen Use to Treat Cluster Headache - 240.2.2
NCD
Multiple documents Icon Home Prothrombin Time INR Monitoring for Anticoagulation Management - 190.11
NCD
Multiple documents Icon Home Use of Oxygen - 240.2
NCD
Multiple documents Icon Home Use of Oxygen in Approved Clinical Trials - 240.2.1
NCD
Multiple documents Icon Hospice--Determinng Terminal Status [L32015, rev. ]
HHH MAC
Multiple documents Icon Hospital and Skilled Nursing Facility Admission Diagnostic Procedures - 70.5
NCD
Multiple documents Icon Hospital Beds - 280.7
NCD
Multiple documents Icon Hospital Beds And Accessories [L11572, rev. HBED010]
DME MAC
Multiple documents Icon Human Chorionic Gonadotropin (hCG) - 190.27
NCD
Multiple documents Icon Human Granulocyte / Macrophage Colony Stimulating Factors [L30306, rev. R6]
Part B
Multiple documents Icon Human Immunodeficiency Virus (HIV) Testing (Diagnosis) - 190.14
NCD
Multiple documents Icon Human Immunodeficiency Virus (HIV) Testing (Prognosis Including Monitoring) - 190.13
NCD
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