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Jurisdiction 1 Part B
Botulinum Toxin: Types A and B Local Coverage Determination

States Applicable to Alert: Northern and Southern California

Background Information: This LCD contains three diagnosis situations: ‘stand alone’, ‘primary’ and ‘secondary’. In order for a service to be covered, a 'stand alone' OR a 'primary' AND a 'secondary' ICD-9 are required in the submission of the claim. Coverage was implemented incorrectly during cutover for this LCD.  All diagnoses indicated in the LCD were covered as 'stand alone'.

This resulted in overpayments to:
  • Botulinum Toxin Types A and B LCD, L28242, effective September 2, 2008.
Applicable Codes:
J0585             64612             64614             64653
J0587             64613             64650             67345

MAC Action: When the system is corrected, a mass adjustment will be performed to collect any overpayments that may have been made.

Provider Action: No action is required.

Date Reported: July 15, 2009
Date Resolved:  N/A

 

last updated on 07/17/2009
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