States Applicable to Alert: Hawaii, Nevada, Guam, American Samoa, the Northern Mariana Islands and California
Background Information: The Monitored Anesthesia Care LCD policy has been retired and all services denied due to the coverage in this policy will be paid back to the effective date of the policy.
- California - Monitored Anesthesia Care LCD - L28279 (Effective September 2, 2008)
- Hawaii/Nevada - Monitored Anesthesia Care LCD - L27707 (Effective August 4, 2008)
Applies To Procedure Code(s):
00100 00522 01730
00124 00524 01780
00148 00530 01916
00160 00532 01920
00164 00702 01922
00300 00740 01935
00400 00810 01936
00410 00920 01999
00520 01420
Remark /Reason Codes:
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 Local Coverage Determination (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 the contractor to request a copy of the LMRP/LCD.
MAC Action: The Monitored Anesthesia Care LCD was retired and all services denied due to this LCD were mass adjusted and paid. There were 1,086 claims adjusted for Hawaii and Nevada; 7,113 claims adjusted for Northern California; and 6,390 claims adjusted for Southern California.
Provider Action: No action required.
Date Reported: January 27, 2008
Date Resolved: February 17, 2009, for Hawaii and Nevada. March 2, 2009, for California.