States Applicable to Alert: Northern and Southern California
Background Information: The procedure codes indicated below are in Overlapping Local Coverage Determination (LCD) Policies.
- Urodynamics and Anorectal Manometery, Anal Electromyography LCD
- Policy L28236 (Dates of service on and after September 2, 2008)
- Policy L19076 (Dates of service October 1, 2006, through September 1, 2008)
- Biofeedback Training for Perineal Muscles and Anorectal or Urethral Sphincters LCD
- Policy L28312 (Dates of service on and after September 2, 2008)
- Policy L12248 (Dates of service October 1, 2006, through September 1, 2008)
Diagnosis coverage was not applied accurately allowing services to be denied incorrectly. The issue was corrected on September 9, 2008.
Applies To Procedure Code(s): 51784 and 51785
Remark and Reason Code:
50 - These are non-covered services because this is not deemed a 'medical necessity' by the payer.
N115 - This decision was based on a Local Medical Review Policy (LMRP) or LCD. An LMRP/LCD provides a guide to assist in determining whether a particular item or service is covered. A copy of this policy is available at www.cms.hhs.gov/mcd or if you do not have Web access, you may contact Palmetto GBA to request a copy of the LMRP/LCD.
MAC Action: The procedure codes in the above LCDs were denying in error. The system has been corrected. A mass adjustment for the claims denied in error was completed on October 10, 2008.
Provider Action: No Action Required
Date Reported: September 8, 2008
Date Resolved: October 10, 2008