Cardiovascular Nuclear Medicine; Myocardial Perfusion Imaging and Cardiac Blood Pool Studies Update
States Applicable to Alert: Hawaii, Nevada, American Samoa, California and the Northern Mariana Islands,
Background Information: Procedure codes in the Cardiovascular Nuclear Medicine; Myocardial Perfusion Imaging and Cardiac Blood Pool Studies LCD were denying in error.
Hawaii, Nevada, American Samoa, Guam and the Northern Mariana Islands
Policy L27894 (Dates of Service on and after 8/4/08)
Policy L23705 (Dates of Service 9/1/07 through 10/31/07)
Policy L10099 (Dates of Service 12/1/06 through 8/31/07)
California
Policy L9441 (Dates of Service 10/1/06 through 9/1/08)
Policy L28246 (Dates of Service on and after 9/2/08)
Applies To Procedure Code(s):
Palmetto GBA internal coverage issues have been corrected for the following procedure codes:
93015 93018 J1250
93016 J0395
93017 J1245
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 an 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: A mass adjustment was completed on January 7, 2009, to pay the services denied in error.
Provider Action: No Action Required
Date Reported: August, 30, 2008
Date Resolved: January 27, 2009