States Applicable to Alert: Hawaii, Nevada, American Samoa and the Mariana Islands
Background Information: Procedure codes in the plastic surgery Local Coverage Determination (LCD) were being denied in error for all diagnoses.
- L28291 (Effective February 26, 2009)
- L27716 (Effective August 4, 2008 to February 26, 2009)
Applies to Procedure Codes:
19316 19324 19325 19328 19330 19340 19342 19350 19342
19350 19355 19357 19361 19364 19366 19367 19368 19369
19370 19371 19380 19396
Modifier: 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 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. If you do not have Web access, you can contact Palmetto GBA to request a copy of the LMRP/LCD.
MAC Action:
A mass adjustment of the applicable claims was completed on April 30, 2009.
Provider Action: No action required.
Date Reported: April 16, 2009
Date Resolved: April 30, 2009