States Applicable to Alert:
Northern and Southern California
Background Information:
As of April 27, 2009, coverage for the Medical Nutrition Therapy NCD was expanded to include the following ICD-9 codes:
V42.0 403.91 593.9
250.90 – 250.93 404.02 – 404.03 648.00 – 648.04
403.01 404.12 – 404.13 648.80 – 648.84
403.11 404.92 – 404.93
Applies To Procedure Codes:
CPT Codes 97802, 97803, 97804 and HCPCS Codes G0270 & G0271
Modifiers:
N/A
Remark /Reason Codes: C
50 – These are non-covered services because this is not deemed a medical necessity by
the payer.
N386 - This decision was based on a National Coverage Determination (NCD). A NCD provides a coverage determination as to whether a particular item or service is covered. A copy of this policy is available at www.cms.hhs.gov/mcd/search.asp. If you do not have Web access, you can contact the contractor to request a copy of the NCD.
MAC Action:
The diagnosis auditing criteria is being updated with the expanded diagnoses codes. Once the maintenance has been completed, a mass adjustment will be requested for claims with date of service on or after April 27, 2009.
A mass adjustment was completed on September 3, 2009. No claims were found for Northern California and two claims were adjusted for Southern California.
Provider Action:
Date Reported: July 9, 2009
Date Resolved: September 3, 2009