Updated: Claims Adjustments for Cardiovascular Nuclear Medicine, Myocardial Perfusion Imaging and Cardiac Blood Pool Studies (Radiology Services)
States Applicable to Alert: Hawaii, Nevada, Samoa, Guam, Northern Marianna Islands and California
Background Information: Procedure codes in the Cardiovascular Nuclear Medicine, Myocardial Perfusion Imaging and Cardiac Blood Pool Studies Local Coverage Determination (LCD) were denied in error.
Hawaii, Nevada, Somoa, Guam and Northern Marianna Islands:
Policy L27894 (Dates of Service on and after August 4, 2008)
Policy L23705 (Dates of Service September 1, 2007 to October 31, 2007)
Policy L10099 (Dates of Service December 1, 2006 to August 31, 2007)
Northern and Southern California:
Policy L9441 (Dates of service October 1, 2006 to September 1, 2008)
Policy L28246 (Dates of service on and after September 2, 2008)
Applies To Procedure Code(s):
78460 78461 78464 78465 78472 78473 78478 78480 78481
78483 78494 78496 A9500 A9502 A9505 A9560 J0152
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 LCD. An LMPR/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. If you do not have Web access, you may contact Palmetto GBA to request a copy of the LMRP/LCD.
MAC Action:
A mass adjustment was completed on February 12, 2009 for Hawaii, Nevada, Somoa, Guam and Northern Marianna Islands and on February 24, 2009 for Northern California and Southern California.
Provider Action: No Action Required
Date Reported: December 11, 2008
Date Resolved: February 24, 2009