Claim Adjustments: Treatment of Ulcers & Symptomatic Hyperkeratoses Local Coverage Determination
States Applicable to Alert: California, Nevada, Hawaii, American Samoa, Guam, Northern Mariana Islands
Background Information:
Procedure codes in the Treatment of Ulcers & Symptomatic Hyperkeratoses Local Coverage Determination (LCD) were being denied in error due to overlapping policies in these areas:
- Northern California and Southern California:
LCD number L28308 (September 2, 2008 and beyond) overlaps with the Routine Foot Care LCD number L28299 (September 2, 2008 and beyond)
- American Samoa, Guam, Hawaii and Northern Mariana Islands:
LCD number L27728 (August 4, 2008 through February 25, 2009) overlaps with the Routine Foot Care LCD number L27720 (August 4, 2008 through February 25, 2009). LCD number L28308 (February 26, 2009 and beyond) overlaps with the Routine Foot Care LCD number L28299 (February 26, 2009 and beyond)
Applies To Procedure Code(s): 11055, 11056 and 11057
Applies To Diagnosis Code(s): 700, 701.1 and 757.39
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 may contact Palmetto GBA to request a copy of the LMRP/LCD.
MAC Action: The procedure codes in the above LCD were being denied in error due to a diagnosis update to the policy. The system has been corrected. A mass adjustment was performed to correct the claims denied in error with dates of service September 2, 2008, through November 6, 2008.
The mass adjustment was completed on November 14, 2008, for Hawaii, American Samoa, Guam, Northern Mariana Islands and on November 20, 2008, for Northern California and Southern California.
Provider Action: No Action Required
Date Reported: October 31, 2008
Date Resolved: November 14, 2008, for Hawaii, American Samoa, Guam and Northern Mariana Islands and November 20, 2008, for Northern California and Southern California