This article describes the consolidation of Local Coverage Determinations (LCDs) for Jurisdiction J (JJ) and serves as notification to the JJ provider community of the consolidated LCDs that will be in effect in JJ following the transition from Cahaba to Palmetto GBA. As per CMS instruction all active Cahaba LCDs were reviewed and consolidated with all active Palmetto GBA Jurisdiction M (JM) AB MAC LCDs. A formal comment period was not required. No substantive LCD revisions were permitted during the JJ LCD consolidation process.

JJ LCD Consolidation Process Diagram

JJ LCD Consolidation Process Diagram

The principle of ‘most clinically appropriate’ LCD was applied to the selection process... The ‘most clinically appropriate’ LCD was defined administratively by evaluating the LCD narrative and scope/impact of the LCD, as described by the ICD-10-CM, CPT and HCPC codes contained in the LCD. The outcome was a single LCD, whenever more than one LCD addressing a single topic was identified. All active LCDs identified are presented here along with a brief narrative describing why the LCD was selected. Following CMS instruction, this article provides a minimum of 45 day notice period for the selected LCDs prior to their becoming effective on January 29, 2018 for Part A providers and February 26, 2018 for Part B providers in JJ.

LCD consolidation is a critical process in the JJ transition and was accomplished using a systematic process. During the LCD consolidation process Palmetto GBA identified all active LCDs in Jurisdiction J, and characterized them by topic and type. The LCDs were cross-referenced to their JM counterparts as it is important to understand how existing Part A LCDs relate to their Part B counterparts. This information will also be important in the coordination of education following the completion of the JJ transition. All selected LCDs and supporting narratives will be posted to the Medicare Coverage Database (MCD) for notification in the JJ Jurisdiction. The MCD is available at: https://www.cms.gov/medicare-coverage-database/

This posting allows Palmetto GBA to meet the aforementioned 45 day notice period and commence education related to the consolidated policies. Again the consolidated JJ LCDs will become effective on January 29, 2018 for Part A JJ providers currently submitting claims to Cahaba and on February 26, 2018 for Part B JJ providers currently submitting claims to Cahaba. As of the segment operational dates noted on the JJ Transition Web page the consolidated JJ LCDs will replace all active LCDs maintained by Cahaba.

Below is the justification narrative supporting Palmetto GBA’s selection of JJ LCDs for physicians and providers currently submitting claims to Cahaba. Please note that the selected JJ LCDs have been assigned new JJ LCD numbers that differ from the original Cahaba numbers used below. The consolidated JJ LCDs will apply to all JJ states.

A LCD crosswalk to the consolidated JJ LCD numbers, newly implemented LCDs, and non-selected LCDs is attached to this article. The full complement of consolidated JJ AB MAC LCDs may be accessed via the previously cited JJ Transition Web page.

Below is the list of selected LCDs with their rationale. The current (active) LCDs may be viewed on the Medicare Coverage Database (MCD) on December 14, 2017, using the search feature and identified policy ID number, at https://www.cms.gov/medicare-coverage-database/.

Part A LCD has a counterpart:

  1. L34549 Ambulance Services – This policy was selected because although both policies communicate clearly the regulatory language contained in the Medicare Benefit Policy Manual, Medicare Claims Processing Manual, and Medicare Program Integrity Manual, the regulatory language is more current in the Palmetto GBA policy.
  2. L34410 B-type Natriuretic Peptide (BNP) Testing – This policy was selected because it clearly communicates the indications and limitations of coverage for BNP Testing.
  3. L34573 Cardiac Event Detection – This policy was selected because it clearly communicates the indications and limitations of coverage for the identified services. The Cahaba policy does not make a clear distinction between short term cardiac monitoring (Holter) and long term monitoring (CED).
  4. L34427 Outpatient Occupational Therapy
    • This policy was selected in relation to L34290 Surgery: Debridement Services because it contains all aspects of care provided by a therapist and ICD-10-CM codes to help providers understand Medicare coverage.
    • This policy was chosen in relation to L34308 Medicine Occupational Therapy – Outpatient. This policy was selected because it clearly communicates the indications and limitations of coverage for Outpatient Occupational Therapy services. In addition the citations of CMS regulatory documents related to this policy are more current.
  5. L34428 Outpatient Physical Therapy
    • This policy was selected in relation to L34290 Surgery: Debridement Services because it contains all aspects of care provided by a therapist and ICD-10-CM codes to help providers understand Medicare coverage.
    • This policy was chosen in relation to L34310 Medicine: Physical Therapy - Outpatient. This policy was selected because it clearly communicates the indications and limitations of coverage for Outpatient Physical Therapy services. In addition the citations of CMS regulatory documents related to this policy are more current.
  6. L34429 Outpatient Speech Language Pathology
    • This policy was selected in relation to L34307 Medicine Dysphagia/Swallowing Therapy because it contains indications, limitations, and ICD-10-CM codes to help providers understand Medicare coverage as it integrates guidance for diagnosis and treatment of conditions leading to speech disorders and swallowing disorders which can occur concomitantly.
    • This policy was selected in relation to L34311 Medicine: Speech Language Pathology - Outpatient because it contains indications, limitations, and more specific ICD-10-CM codes to help providers understand Medicare coverage. The Cahaba LCD contains CPT codes for neurobehavioral testing which are peripheral to speech language therapy and should not be included in a policy specific to speech language pathology.

Part B LCD has a counterpart:

  1. L33416 3D Interpretation and Reporting of Imaging Studies
    • This policy was selected in relation to L34277 Radiology: Computed Tomography of the Abdomen and Pelvis because it contains indications, limitations, more current references and ICD-10-CM codes to help providers understand Medicare coverage.
    • This policy was selected in relation to L34278 Radiology: Magnetic Resonance Imaging of the Brain because it clearly communicates the indications and limitations of current coverage.
  2. L33418 Assays for Vitamins and Metabolic Function
    • This policy was selected in relation to L34272 Pathology and Laboratory: C-Reactive Protein; High Sensitivity (hsCRP) because it contains broader indications to help providers understand Medicare coverage.
    • This policy was selected in relation to L34274 Pathology and Laboratory: Vitamin D Assay Testing because it contains broader indications to help providers understand Medicare coverage.
  3. L33422 B-type Natriuretic Peptide (BNP) Level – This policy was selected because it clearly communicates the indications and limitations of coverage for BNP Testing.
  4. L33458 Chemodenervation – This policy was selected because it clearly communicates the indications and limitations of coverage that are appropriate for each individual drug used in chemodenervation as each drug has a unique set of FDA label indications.
  5. L37387 Chiropractic Services – This policy was selected because it clearly communicates the indications and limitations of coverage for chiropractic services. The Cahaba policy has not been updated to reflect the more comprehensive language incorporated into the LCD Writers draft Chiropractic Services LCD which was adopted by Palmetto GBA.
  6. L33461 Implantable Infusion Pump – This policy was selected because it contains indications, limitations, and ICD-10-CM codes to help providers understand Medicare coverage.
  7. L35148 Lumbar Epidural Steroid Injections – This policy was selected because it contains indications, limitations, and ICD-10-CM codes to help providers understand Medicare coverage.
  8. L35071 MolDX: Circulating Tumor Cell Marker Assays – This policy was selected because it is the most up to date and is a non-coverage policy. The Cahaba policy contains limited coverage in the colon, breast and prostate.
  9. L35024 MolDX: Genetic Testing for Lynch Syndrome – This policy was selected because it contains indications and ICD-10-CM codes to help providers understand Medicare coverage.
  10. L33438 Octreotide Acetate for Injectable Suspension (Sandostatin LAR depot) – This policy was selected because it contains indications and ICD-10-CM codes to help providers understand Medicare coverage. The Cahaba policy contains an off label indication, pancreatic fistula, which is non-covered and should not be listed in a coverage policy.
  11. L33443 Posterior Tibial Nerve Stimulation (PTNS) for Urinary Control – This policy was selected because it contains indications, current references, and more specific ICD-10-CM codes to help providers understand Medicare coverage.
  12. L34869 Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder – This policy was selected because it contains indications, limitations, and ICD-10-CM codes to help providers understand Medicare coverage. The Cahaba policy does not address criteria for retreatment of reoccurring symptoms.
  13. L33473 Vertebroplasty/Kyphoplasty – This policy was selected because it contains indications, current references, and additional ICD-10-CM codes for palliative care to help providers understand Medicare coverage.
  14. L33452 Virtual Colonoscopy (CT Colonography) – This policy was selected because it contains indications, limitations, and more specific ICD-10-CM codes to help providers understand Medicare coverage.

A/B MAC LCD has a counterpart:

  1. L35724 Controlled Substance Monitoring and Drugs of Abuse Testing
    • This policy was selected in relation to L34501 Pathology and Laboratory: Qualitative Drug Testing because it is more comprehensive and will limit frequency over-utilization and inappropriate use of urine drug testing.
    • This policy was selected in relation to L35920 Pathology and Laboratory: Quantitative Drug Testing because it contains indications, more specific ICD-10-CM codes, and specific street names of drugs to help providers understand Medicare coverage.
  2. L34555 Non-Covered Category III CPT Codes
    • This policy was selected in relation to L34292 Surgery Interventional Renal Denervation (IRD) for Resistant Hypertension because it lists the correct CPT codes representing unilateral and bilateral renal denervation procedures, 0338T and 0339T, respectively.
    • This policy was selected in relation to L34279 Radiology: Myocardial Perfusion Imaging (MPI) because CPT code 0439T myocardial contrast perfusion echocardiography is non-covered as it is considered investigational and should not be included in the Cahaba coverage LCD.
    • This policy was selected in relation to L34291 Surgery: Injections of the Spinal Canal because it contains limitations and CPT codes to help providers understand non-covered services for Medicare.
    • This policy was selected in relation to L34293 Surgery: Lumbar Facet Blockade because it contains limitations and CPT codes to help providers understand non-covered services for Medicare.
    • This policy was selected in relation to L34300 Surgery: Vertebral Augmentation Procedures (VAPs) because CPT code 0200T percutaneous sacral augmentation (sacroplasty), unilateral injection(s) and 0201T percutaneous sacral augmentation (sacroplasty), bilateral injections are considered non-covered and should not be included in the Cahaba coverage LCD.
  3. L36954 Noncovered Services other than CPT® Category III Noncovered Services
    • This policy was selected in relation to L35941 Medicine: Psychotherapy Services because CPT code 90849 multiple-family group therapy is considered non-covered and should not be included in the Cahaba coverage LCD.
    • This policy was selected in relation to L36945 Medicine: Bioimpedence Spectroscopy (BIS) Devices for the Detection and Management of Lymphedema because it lists the correct CPT codes representing bioimpedence spectroscopy, 93702.
    • This policy was selected in relation to L35942 Surgery: Fusion for Degenerative Joint Disease of the Lumbar Spine because the Cahaba LCD includes coverage for CPT codes 22856, 22857, 22858 for total disc arthroplasty (artificial disc), anterior approach which are currently non-covered in L36954. NCD 150.10 precludes coverage for 1 specific artificial disc, and leaves coverage for the other available artificial discs to the discretion of the contractors. This policy was selected in relation to L34308 Medicine Occupational Therapy - Outpatient because it lists the correct CPT codes in reference to non-covered occupational therapy services.
    • This policy was chosen in relation to L34310 Medicine: Physical Therapy – Outpatient because it lists the correct CPT codes in reference to non-covered physical therapy services.
  4. L36466 Application of Skin Substitutes – This policy was selected because it contains indications including multiple types of skin substitutes and ICD-10-CM codes to help providers understand Medicare coverage.
  5. L34411 Blepharoplasty, Eyelid Surgery, and Brow Lift – This policy was selected because it contains indications and more specific ICD-10-CM codes to help providers understand Medicare coverage.
  6. L33423 Cardiac Computed Tomography & Angiography (CCTA) – This policy was selected because it contains indications, limitations, references, and more specific ICD-10-CM codes to help providers understand Medicare coverage. CPT code 75571 computed tomography, heart, without contrast material, with quantitative evaluation of coronary calcium is considered covered and should not be listed as non-covered in the Cahaba LCD.
  7. L33457 Cardiac Radionuclide Imaging – This policy was selected because it clearly communicates the indications and limitations of coverage for cardiac imaging studies.
  8. L34413 Cataract Surgery – This policy was selected because it contains indications, references, and more specific ICD-10-CM codes to help providers understand Medicare coverage. The Cahaba policy contains an unrelated CPT code 66930 Removal of lens material; intracapsular, for dislocated lens that should not be listed in a policy addressing cataract extraction.
  9. L34454 Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy – This policy was selected because it contains indications, limitations, and ICD-10-CM codes to help providers understand Medicare coverage. The Cahaba policy contains CPT code 45398 Colonoscopy, flexible; with band ligation(s) (e.g., hemorrhoids) that should not be included in the specific policy.
  10. L33428 Cosmetic and Reconstructive Surgery – This policy was selected because it contains indications and ICD-10-CM codes to help providers understand Medicare coverage.
  11. L34415 CT of the Abdomen and Pelvis – This policy was selected because it contains more specific procedure descriptions and their indications and more current references to help providers understand Medicare coverage.
  12. L36471 Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy – This policy was selected because it contains indications, and ICD-10-CM codes to help providers understand Medicare coverage.
  13. L35677 Infliximab – This policy was selected because it affords more comprehensive coverage guidance for off label indications currently supported by official Medicare compendia. The Cahaba policy does not directly address the root cause of improper payment, namely insufficient documentation to support off-label indications.
  14. L34580 Intravenous Immunoglobulin (IVIG) – This policy was selected because it contains indications and ICD-10-CM codes to help providers understand Medicare coverage. The Cahaba policy contains an off label indication, parvovirus B19, which is non-covered and should not be listed in a coverage policy.
  15. L36129 MolDX: Biomarkers in Cardiovascular Risk Assessment – This policy was selected because it covers hsCRP for a narrow range of indications and the Cahaba policy non-covers hsCRP.
  16. L36082 MolDX: BRCA1 and BRCA2 Genetic Testing – This policy was selected because it is the most up to date (according to the 2017 NCCN) and is less restrictive.
  17. L35072 MolDX: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing – This policy was selected because it includes the use of CPT code 81479 unlisted molecular pathology procedure to prevent labs from circumventing the policy.
  18. L36033 MolDX: HLA-B*15:02 Genetic Testing – This policy was selected because the Cahaba policy attempts to describe many testing scenarios (e.g., transplantation) thus potentially limiting coverage as science evolves.
  19. L36464 MolDX: HLA-DQB1*06:02 Testing for Narcolepsy – This policy was selected because the Cahaba policy attempts to describe many testing scenarios (e.g., transplantation) thus potentially limiting coverage as science evolves.
  20. L36074 MolDX: Molecular RBC Phenotyping – This policy was selected because it lists the more specific CPT code and specifies acceptable ICD-10 indications.
  21. L36143 MolDX: NSCLC, Comprehensive Genomic Profile Testing – This policy was selected because the Cahaba policy doesn’t recognize previous NGS testing and assays for EGFR, ALK, and ROS1.
  22. L35048 Nerve Conduction Studies and Electromyography – This policy was selected because it incorporates detailed guidance regarding acceptable credentials of providers performing these studies, indications, limitations and ICD-10-CM codes to help providers understand Medicare coverage.
  23. L36593 Polysomnography – This policy was selected because it clearly communicates the indications and limitations of coverage for all forms of polysomnography. The Cahaba policy only addresses Home Sleep Testing (HST).
  24. L33445 Removal of Benign and Malignant Skin Lesions – This policy was selected because it contains broader indications and more specific ICD-10-CM codes to help providers understand Medicare coverage.
  25. L35026 Rituximab (Rituxan®) – This policy was selected because it affords more comprehensive coverage guidance for off label indications currently supported by official Medicare compendia. The Cahaba LCD is only a Part A policy which does not address a significant portion of utilization of this drug in the Part B setting. In addition the Cahaba policy does not directly address the root cause of improper payment, namely insufficient documentation to support off-label indications. While specific off- label indications are listed, providers are referred to Chapter 15, Section 50.4.5 of the Medicare Benefit Policy Manual for general instructions regarding Off-label use of Drugs and Biologicals in an Anti-cancer Chemotherapeutic Regimen.
  26. L34433 Somatosensory Testing – This policy was selected because it contains indications and ICD-10-CM codes to help providers understand Medicare coverage.
  27. L36879 Surgery: Spinal Cord Stimulators for Chronic Pain – This policy was selected because it contains more specific CPT/HCPCS codes to help providers understand Medicare coverage.
  28. L33456 Total Joint Arthroplasty – This policy was selected because it contains indications, limitations, references, and ICD-10-CM codes to help providers understand Medicare coverage.
  29. L34434 Upper Gastrointestinal Endoscopy and Visualization – This policy was selected because it contains broader indications and ICD-10-CM codes to help providers understand Medicare coverage.
  30. L37176 White Cell Colony Stimulating Factors – This policy was selected because it affords more comprehensive coverage guidance for off label indications currently supported by official Medicare compendia. The Cahaba policy does not address indications or HCPCS coding (Q5101) for the biosimilar drug Zarzio.
  31. L36427 Wireless Capsule Endoscopy – This policy was selected because it contains indications, limitations, and ICD-10-CM codes to help providers understand Medicare coverage. The Cahaba policy contains a non-covered diagnosis R19.5 other fecal abnormalities that should not be listed in this coverage policy.

Cahaba LCDs that do not have a counterpart and were compared to 'no policy':
Some LCDs do not have counterparts and were compared to 'no policy'. In these instances 'no policy' may be considered, however, the recommendation must be justified. In these circumstances Palmetto GBA weighed the burden to physician and non-physician providers, and the risk to the Medicare program, of having 'no policy'.

The following Part A Cahaba LCDs do not have a Palmetto GBA counterpart and were not selected for implementation:

  1. L34303 Drugs and Biologicals: Bevacizumab (Avastin®)
  2. L34304 Drugs and Biologicals: Gemcitabine Hydrochloride (Gemzar®)
  3. L34305 Drugs and Biologicals: Oxaliplatin (Eloxatin®)

These three policies do not directly address the root cause of improper payment, namely insufficient documentation to support off-label indications. While specific off- label indications are listed, providers are referred to Chapter 15, Section 50.4.5 of the Medicare Benefit Policy Manual for general instructions regarding Off-label use of Drugs and Biologicals in an Anti-cancer Chemotherapeutic Regimen.

Palmetto GBA will publish an article addressing the limited coverage described in Chapter 15, Section 50.4.2 titled Unlabeled Use of a Drug. According to the OIG 'providers should indicate the unlabeled use of a drug or biological' and 'use the remarks section of the claim for this purpose (see OIG Report A-03-13-00011).

The following Part B Cahaba LCDs do not have a Palmetto GBA counterpart and were not selected for implementation:

  1. L34284 Surgery: Arthrocentesis, Aspiration, and/or Injection: Major Joint or Bursa – The policy lists several indications, but no limitations of coverage. A more robust LCD would be of greater benefit to providers.

The following A/B MAC Cahaba LCDs do not have a Palmetto GBA counterpart and were not selected for implementation:

  1. L34260 Drugs and Biologicals: Zoledronic Acid – The improper payment associated with zoledronic acid is principally due to the dose vs. number of units billed. This is being addressed through a medically unlikely edit (MUE) based on prescribing information.
  2. L34500 Medicine: Autonomic Function Tests – The policy contains an unrelated CPT Code (CPT 0007M) that should not be listed in a policy addressing autonomic function tests.
  3. L34263 Medicine: Hydration Therapy – The policy provides several coding and billing instructions. Palmetto GBA will utilize a comprehensive article to convey the proper coding and billing of hydration services (currently Palmetto GBA article A53778)
  4. L34282 Radiology: Proton Beam Therapy – The information supporting 'Group 2' indications is not as clear as 'Group 1' indications; Palmetto GBA will disseminate an article titled Billing Instructions for Investigational Device Exemptions (IDE) to communicate the coverage available under IDEs and NCD 310.1 (Routine Costs in Clinical Trials) see Medicare National Coverage Determination Manual (CMS Publication 100-03, Chapter 1, Part 4, Section 310.1)
  5. L34283 Radiology: Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT) – The policy does not list ICD-10-CM codes that support medical necessity and is therefore not the most clinically appropriate LCD. A more comprehensive LCD addressing SRS and SBRT, which included ICD-10-CM coding would be of greater benefit to providers.
  6. L36084 Surgery: Leadless Cardiac Pacemaker – This policy has been superseded by NCD 20.8.4 – (Leadless Pacemakers) see Medicare National Coverage Determination Manual (CMS Publication 100-03, Chapter 1, Part 1, Section 20.8.4)
  7. L35889 Surgery: Left Atrial Appendage – This policy has been superseded by NCD 20.34 [Percutaneous Left Atrial Appendage Closure (LAAC)] see Medicare National Coverage Determination Manual (CMS Publication 100-03, Chapter 1, Part 1, Section 20.34)
  8. L35658 Surgery: Implantable Hormone Pellets – The information in the policy is insufficient to reliably select appropriate candidates. No symptoms and signs suggestive of hypogonadism are discussed. The establishment of hypogonadism using testosterone levels did not indicate that the levels should be taken in the morning, as recommended by evidence-based clinical practice guidelines.

The following Part A Palmetto GBA LCDs do not have a Cahaba counterpart but were selected for implementation because they will increase coverage consistency throughout JJ:

  1. L34416 Computerized Axial Tomography of the Chest/Thorax
  2. L34574 Dental Services
  3. L34575 Frequency of Dialysis
  4. L34419 Homocysteine Level, Serum
  5. L34422 Infrared Coagulation (IRC) of Hemorrhoids
  6. L34424 Magnetic Resonance Angiography 
  7. L34425 Magnetic Resonance Imaging of the Orbit, Face, and/or Neck
  8. L34551 One Day Stays for Chest Pain
  9. L34552 Outpatient Observation Bed/Room Services
  10. L34570 Psychiatric Inpatient Hospitalization
  11. L34430 Respiratory Therapy (Respiratory Care)
  12. L34553 Stretta Procedure
  13. L34578 Surface Electrical Stimulation in the Treatment of Dysphagia

The following Part B Palmetto GBA LCDs do not have a Cahaba counterpart but were selected for implementation because they will increase coverage consistency throughout JJ:

  1. L33417 Allergy Skin Testing
  2. L33459 Computerized Axial Tomography (CT), Thorax
  3. L36761 GlycoMark Testing for Glycemic Control
  4. L33431 HbA1c
  5. L33432 Hyaluronate Polymers
  6. L34554 In Vitro Chemosensitivity & Chemoresistance Assays
  7. L33436 Mohs Micrographic Surgery (MMS)
  8. L36665 MolDX- CDD: ProMark Risk Score
  9. L35631 MolDX: Breast Cancer Index℠ Genetic Assay
  10. L35633 MolDX: GeneSight® Assay for Refractory Depression
  11. L35632 MolDX-CDD: ConfirmMDx Epigenetic Molecular Assay
  12. L35868 MolDX-CDD: Decipher® Prostate Cancer Classifier Assay
  13. L35869 MolDX-CDD: Prolaris™ Prostate Cancer Genomic Assay
  14. L33444 Pulmonary Stress Testing
  15. L33446 Respiratory Therapy and Oximetry Services
  16. L33447 Special Electroencephalography
  17. L33449 Swallowing Studies for Dysphagia
  18. L33454 Varicose Veins of the Lower Extremities
  19. L34537 Vestibular Function Testing
  20. L33455 Wireless Gastrointestinal Motility Monitoring Systems

The following A/B MAC Palmetto GBA LCDs do not have a Cahaba counterpart but were selected for implementation because they will increase coverage consistency throughout JJ:

  1. L33420 Bladder/Urothelial Tumor Markers
  2. L34412 Cardiac Rehabilitation
  3. L37022 Coenzyme Q10 (CoQ10)
  4. L34512 Corneal Pachymetry
  5. L34417 CT of the Head
  6. L37379 Echocardiography
  7. L34513 Flow Cytometry
  8. L33433 Infectious Disease Molecular Diagnostic Testing
  9. L34576 Laparoscopic Sleeve Gastrectomy for Severe Obesity
  10. L36109 Minimally Invasive Treatment for Benign Prostatic Hyperplasia Involving Prostatic Urethral Lift (Urolift®)
  11. L36763 MolDX: 4Kscore Assay
  12. L37266 MolDX: AlloSure® Donor-Derived Cell-Free DNA Test
  13. L36827 MolDX: APC and MUTYH Gene Testing
  14. L36125 MolDX: Breast Cancer Assay: Prosigna
  15. L36483 MolDX: Chromosome 1p/19q Deletion Analysis
  16. L37033 MolDX: DecisionDx-UM (Uveal Melanoma)
  17. L37264 MolDX: EndoPredict Breast Cancer Gene Expression Test
  18. L36044 MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease
  19. L36089 MolDX: Genetic Testing for Hypercoagulability / Thrombophilia (Factor V Leiden, Factor II Prothrombin, and MTHFR)
  20. L35974 MolDX: MGMT Promoter Methylation Analysis
  21. L35025 MolDX: Molecular Diagnostic Tests (MDT)
  22. L35073 MolDX: NRAS Genetic Testing
  23. L36912 MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health™)
  24. L37262 MolDX: Oncotype DX® Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer
  25. L36854 MolDX: Percepta© Bronchial Genomic Classifier
  26. L37043 MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease
  27. L37260 MolDX: Prometheus IBD sgi Diagnostic Policy
  28. L37031 MolDX: Xpresys Lung
  29. L36153 MolDX: Genomic Health™ Oncotype DX® Prostate Cancer Assay
  30. L34426 Ophthalmic Angiography (Fluorescein and Indocyanine Green)
  31. L33467 Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
  32. L34577 Retroperitoneal Ultrasound
  33. L34431 Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
  34. L35922 Special Histochemical Stains and Immunohistochemical Stains

The 10 currently active Cahaba LCDs listed below were selected for implementation in both Jurisdiction J and Jurisdiction M. In addition to the 10 LCDs below, the Jurisdiction M Part B Spinal Cord Stimulators for Chronic Pain L34556 is being retired February 25, 2018 and is being replaced with Spinal Cord Stimulators for Chronic Pain L37632 effective January 29, 2018 for Part A services and February 26, 2018 for Part B services. This article serves as formal notification for both jurisdictions.

The following Part A Cahaba LCD does not have a Palmetto GBA counterpart but was selected for implementation because it will increase coverage consistency throughout JJ:

  1. L34309 Medicine: Partial Hospitalization Programs – This policy was selected because it clearly communicates the indications and limitations of coverage for partial hospitalization programs and will complement the Psychiatric Inpatient Hospitalization LCD currently in place in AB MAC Jurisdiction M.

The following Part B Cahaba LCDs do not have a Palmetto GBA counterpart but were selected for implementation because they will increase coverage consistency throughout JJ:

  1. L34280 Radiology: Nonobstetric Pelvic Ultrasound - This policy was selected because it clearly communicates the indications and limitations of coverage for nonobstetric pelvic ultrasounds.
  2. L34299 Surgery: Trigger Point Injections - This policy was selected because it contains indications and limitations to help providers understand Medicare coverage.

The following A/B MAC Cahaba LCDs do not have a Palmetto GBA counterpart but were selected for implementation because they will increase coverage consistency throughout JJ:

  1. L34262 Medicine: Health and Behavior Assessment/Intervention – This policy was selected because it clearly communicates the indications and limitations of coverage for the clinical psychologist services represented by CPTs 96150 – 96155.
  2. L34267 Medicine: Noninvasive Peripheral Arterial and Venous Studies - This policy was selected because it clearly communicates the indications and limitations of coverage for the specified noninvasive peripheral arterial and venous studies.
  3. L36743 Radiology: Intensity Modulated Radiation Therapy (IMRT) – This policy was selected because it clearly communicates the indications and limitations of coverage for IMRT services.
  4. L34289 Surgery: Continuous Peripheral Nerve Blocks (CPNB) – This policy was selected because it contains indications, limitations, and ICD-10-CM codes to help providers understand Medicare coverage.
  5. L34295 Surgery: Nerve Blocks and Electrostimulation for Peripheral Neuropathy - This policy was selected because it contains evidenced-based limitations of coverage to help providers understand Medicare coverage.
  6. L34944 Surgery: Routine Foot Care - This policy was selected because it clearly communicates the indications and limitations of coverage for the identified services.
  7. L34301 Surgery: YAG Capsulotomy - This policy was selected because it clearly communicates the indications and limitations of coverage for CPT 66821.

Contact Palmetto GBA JJ Part B Medicare

Provider Contact Center: 877-567-7271

Email JJ Part B

Contact a specific JJ Part B department


Click to Chat Now