States Applicable to Alert: Southern California only.
Background Information: Procedure codes in this LCD were denying in error. The ICD-9 diagnosis code range 953.0 through 953.5 is being added to the system.
The following LCDs are involved:
• L20716: February 19, 2007, to September 1, 2008.
• L28282: After September 2, 2008.
Applies To Procedure Code(s):
95860, 95861, 95863, 95864, 95865, 95866
95867, 95868, 95869, 95870, 95873, 95874
95900, 95903, 95904, 95921, 95922, 95923
95925, 95926, 95927, 95934, 95934, 95936
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 learning if 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: Additional ICD-9 diagnosis codes are being added to the system. When the system is updated, a mass adjustment will be performed to correct the services denied in error.
A mass adjustment on 1,175 claims was completed on April 14, 2009.
Provider Action: No Action Required.
Date Reported: March 6, 2009
Date Resolved: April 14, 2009