Update: LCD Diagnosis Coverage Will Not Be Applied Under HCPCS Procedure Code A9500
States Applicable to Alert: Hawaii, Nevada, Guam, American Samoa, Northern Mariana Islands and California.
Background Information: HCPCS Procedure Code A9500 is included in the Cardiovascular Nuclear Medicine: Myocardial Perfusion Imaging and Cardiac Blood Pool Studies LCD for J1. The J1 CMD has recently determined that pre-pay diagnosis coverage will not be applied to this procedure code as it can be billed and covered for services outside this LCD.
Applies To Procedure Code(s): CPT Code A9500 – Technitium TC-99M Sestamibi, Diagnostic, per study dose, up to 40 millicuries.
Modifier(s): N/A
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 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 or if you do not have Web access, you may contact the contractor to request a copy of the LMRP/LCD.
15.04 - The information provided does not support the need for this service or item.
MAC Action: Palmetto GBA maintenance to remove HCPCS Procedure Code A9500 from internal diagnosis requirements has been completed. For Hawaii and Nevada, 122 Claims were adjusted. For Northern California, 281 claims were adjusted and for Southern California, 491 claims were adjusted.
Provider Action: None
Date Reported: March 9, 2009
Date Resolved: April 27, 2009