States Applicable to Alert: American Samoa, Guam, Hawaii, Nevada, the Northern Mariana Islands and California
Background Information: These two tests are used for tone hearing impairment which may have nothing to do with the vestibular functioning (balance).
Vestibular Function Testing LCD - Policy L28314 - Dates of Service on and after August 4, 2008 for American Samoa, Guam, Hawaii, Nevada, Northern Mariana Islands and Dates of Service on and after September 2, 2008 for Northern California and Southern California.
Applies To Procedure Code(s):
92552 and 92553
MAC Action: A Mass Adjustment was completed on June 5, 2009. This adjustment was for services denied with Reason/Remark Codes of 50 and N115 between August 4, 2008, and May 26, 2009, for American Samoa, Guam, Hawaii, Nevada and the Northern Mariana Islands, and between September 2, 2008, and May 26, 2009, for California.
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 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.
Provider Action: None required.
Date Reported: May 13, 2009
Date Resolved: June 9, 2009