Automated Medical Review You could download from the below link. http://medicare.fcso.com/wrapped/274350.zip |
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Line of Business |
Jurisdiction | Provider Type | Description | Date Implemented |
Date Last Revised |
Part B | JN | All Specialties | Allergy Testing 86003 utilization parameter |
30-09-2010 | N/A |
Part B | JN | Excludes Specialties 18, 41 & 49 |
Amniotic Membrane-Sutureless Placement on the Ocular Surface, deny 65778 when rendering specialty is not 18, 41 or 49 |
29-06-2015 | N/A |
Part B | JN | All Specialties | Application of Skin Substitute Grafts for Treatment of DFU and VLU of Lower Extremities, Deny Q4112, Q4113, Q4114, Q4139, Q4145, Q4149, Q4155 as not medically reasonable and necessary |
08-09-2015 | N/A |
Part B | JN | All Specialties | Arthrocentesis Deny 20610 if J7321, J7323-J7327 is denied |
27-09-2007 | 01-01-2015 |
Part B | JN | All Specialties | Autonomic Function Test Deny 95943 non covered |
24-03-2014 | N/A |
Part B | JN | All Specialties | Bisphosphonates J0897 quantity billed and procedure to diagnosis |
14-10-2013 | 13-05-2015 |
Part B | JN | All Specialties | Bisphosphonates J3489 quantity billed and procedure to diagnosis |
01-07-2013 | 01-01-2014 |
Part B | JN | All Specialties | Bisphosphonates J3489 utilization parameter |
01-07-2013 | 01-01-2014 |
Part B | JN | All Specialties | Cardiovascular Nuclear Imaging Studies 78452/78454 utilization parameter | 01-01-2010 | N/A |
Part B | JN | All Specialties | Collagenase (Xiaflex) Deny 54200/54235 when J0775 is denied same date of service |
14-05-2014 | N/A |
Part B | JN | All Specialties | Collagenase (Xiaflex) 20527/26341 utilization parameter |
06-04-2015 | N/A |
Part B | JN | All Specialties | CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing Deny 81227 and 81355 non covered |
03-11-2014 | N/A |
Part B | JN | All Specialties | Destruction Of Paravertebral Facet Joint Nerve (S) Utilization Parameter |
26-01-2010 | 01-01-2012 |
Part B | JN | All Specialties | Endoscopic Treatment Of Gastroesophageal Reflux Disease (Gerd) Deny 43257, C9724 non covered |
12-06-2012 | N/A |
Part B | JN | All Specialties | Erythropoiesis Stimulating Agents Deny J0882 or J0886 billed without HCT or HGB |
28-02-2002 | 20-10-2010 |
Part B | JN | All Specialties | Erythropoiesis Stimulating Agents J0890 Deny non covered |
02-05-2013 | N/A |
Part B | JN | All Specialties | Erythropoiesis Stimulating Agents J0888 Deny if not billed with Modifier EC |
13-01-2015 | N/A |
Part B | JN | All Specialties | Flow Cytometry 88185 utilization parameter |
30-09-2010 | N/A |
Part B | JN | All Specialties | Fundus Photography & SCODI, Deny 92250 billed on the same date of service with 92133, 92134 |
13-02-2011 | N/A |
Part B | JN | All Specialties | Fundus Photography & SCODI,Deny 92133 or 92134 billed on the same date of service with 92250 (Modifier 59) |
13-02-2011 | 07-04-2011 |
Part B | JN | All Specialties | G-CSF (Neupogen, Granix), Deny J1442, J1446 billed with certain codes in range J9000-J9999 |
25-02-2005 | 01-01-2014 |
Part B | JN | All Specialties | Heparin Injection Deny J1642 billed with administration code same date of service |
11-11-2011 | 13-12-2012 |
Part B | JN | All Specialties | Implantable Miniature Telescope (IMT), Deny 0308T & C1840 based on bene & date of service |
11-02-2015 | 11-02-2015 |
Part B | JN | All Specialties | Long-Term Wearable Electrocardiographic Monitoring 93228, 93229 utilization parameter |
26-10-2012 | NA |
Part B | JN | All Specialties | Long-Term Wearable Electrocardiographic Monitoring 93268, 93270, 93271, 93272 utilization parameter |
26-10-2012 | 03-12-2013 |
Part B | JN | All Provider Types |
Low Density Lipoprotein (LDL) Apheresis utilization parameter |
03-11-2014 | N/A |
Part B | JN | All Specialties | Magnetic Resonance Angiography (MRA) 72159, 73225, C8931-C8936 Deny non-covered |
04-08-2011 | N/A |
Part B | JN | All Specialties | Manipulation Under Anesthesia, Deny 22505 non-covered |
25-01-2010 | N/A |
Part B | JN | All Specialties | Manipulation Under Anesthesia, Deny 27194 billed on the same date of service with 23700, 24300 or 27570 |
25-01-2010 | N/A |
Part B | JN | All Specialties | Molecular Pathology Procedures non- covered see LCD 33703 |
07-10-2013 | 01-01-2015 |
Part B | JN | All Specialties | Monitored Anesthesia Care 01991/01992 with Specific Procedures & QS Modifier |
25-01-2010 | N/A |
Part B | JN | All Specialties | Nerve Conduction Studies & Electromyography 95860-95872, 95885-95887, 95907-95913 utilization parameter |
30-07-2014 | 06-08-2014 |
Part B | JN | All Specialties | Non-Covered Codes By LCD |
13-02-2011 | 09-09-2015 |
Part B | JN | All Specialties | Non-Covered Services, Deny 0387T-0391T if not billed in a clinical trial |
29-06-2015 | N/A |
Part B | JN | Ambulance | Non-Emergency Ground Ambulance Services Deny mileage (A0425) if transport denied (A0426-A0429, A0433 OR A0434) |
27-10-2009 | N/A |
Part B | JN | Ambulance | Non-Emergency Ground Ambulance Services, Deny mileage (A0425) if transport denied (A0426 or A0428) |
30-06-2009 | 21-12-2011 |
Part B | JN | All Specialties | Non-Invasive Evaluation of Extremity Veins Deny 93965 billed on the same date of service with 93970 or 93971 |
23-01-2011 | N/A |
Part B | JN | All Specialties | Noninvasive Physiologic Studies Of Upper & Lower Extremity Arteries Deny 93922-93924 billed on the same date of service with 93925, 93926 |
31-01-2012 | N/A |
Part B | JN | All Specialties | Ocular Photodynamic Therapy (Opt) With Verteporfin Deny 67221 if J3396 not billed |
16-07-2013 | N/A |
Part B | JN | All Specialties | Ophthalmological Services Deny 92002 or 92004 billed with 92226 |
02-02-2009 | N/A |
Part B | JN | All Specialties | Paravertebral Facet Joint Blocks Deny drug codes if joint injection denied |
14-12-2009 | 04-02-2011 |
Part B | JN | All Specialties | Peripheral Nerve Blocks 64400-64455 utilization parameter |
17-03-2014 | 10-04-2014 |
Part B | JN | All Specialties | Posterior Tibial Nerve Stimulation (Ptns) 64566 utilization parameter |
31-01-2012 | N/A |
Part B | JN | All Specialties | Qualitative Drug Screening G0431, G0434, or G6058 Deny 82570 or 81003 if billed on the same date of service |
25-01-2010 | 01-06-2015 |
Part B | JN | All Specialties | Qutenza (Capsaicin) J7335, J7336 Deny if billed without 64999 |
01-01-2011 | 01-01-2015 |
Part B | JN | All Specialties | Rhythm ECG Deny 93042 billed with inpatient or emergency evaluation and management services |
23-08-2010 | N/A |
Part B | JN | All Specialties | Skin Substitutes Non-Covered see LCDs L29279/L29393 |
30-06-2009 | 01-01-2015 |
Part B | JN | All Specialties | Spinal Cord Stimulation for Chronic Pain, 63655 Utilization Parameter overtime |
07-02-2015 | 07-02-2015 |
Part B | JN | All Specialties | Spinal Cord Stimulation for Chronic Pain 63655, Place of Service Other Than 21, 22, 24 |
07-02-2015 | 07-02-2015 |
Part B | JN | All Specialties | Surgical Management Of Morbid Obesity, Deny 43843, 43886, 43887, 43888 non-covered |
13-02-2011 | N/A |
Part B | JN | All Specialties | Surgical Treatment of Nails 11730, 11732, 11750, 11765 Deny without modifiers TA, T1-T9, FA, F1-F9 |
11-02-2013 | N/A |
Part B | JN | All Specialties | Surgical Treatment of Nails 11730/11732 Utilization Parameter |
11-02-2013 | N/A |
Part B | JN | All Specialties | Total Calcium 82310 Phosphorus 84100 utilization parameter |
07-04-2008 | 09-10-2008 |
Part B | JN | Excluding Specialties 13 & 26 |
Transcranial Magnetic Stimulation For Major Depressive Disorder Deny 90867, 90868, 90869 if not specialty 13 or 26 |
07-07-2014 | N/A |
Part B | JN | All Specialties | Transplantation Immune Cell Function Assay (IMMUKNOW) Deny 86352 non-covered |
29-01-2013 | N/A |
Part B | JN | All Specialties | Tysabri J2323 utilization parameter |
09-06-2010 | 09-12-2011 |
Part B | JN | All Specialties | Vertebroplasty, Vertebral Augmentation Deny 22510-22515, 22520-22525 billed without 72291-72292 |
31-03-2014 | 01-01-2015 |
Part B | JN | All Specialties | Vertebroplasty, Vertebral Augmentation utilization parameter |
31-03-2014 | 01-01-2015 |
Part B | FL/US Virgin Islands |
Specialties 50, 89, 97 |
Vestibular Function Tests |
30-09-2014 | N/A |
Part B | JN | All Specialties | Viscosupplementation Therapy for Knee J7321, J7323, J7324, J7325 and J7327 utilization parameter of codes overtime |
01-01-2010 | 11-06-2015 |
Part B | JN | All Specialties | Viscosupplementation Therapy for Knee J7325 utilization parameter (units billed) |
01-01-2010 | N/A |
Part B | JN | All Specialties | Viscosupplementation Therapy for Knee J7326 and J7327 lifetime utilization parameter |
11-06-2015 | N/A |
Part B | JN | All Specialties | VISCO and Imaging Modalities, Deny 77012, 77021, 76881, 76882 or 76942 billed on the same date of service with J7321, J7323, J7324, J7325, J7326 or J7327 |
26-11-2014 | 01-01-2015 |
Part B | JN | All Specialties | Wound Debridement Services 97597 utilization parameter |
08-06-2012 | N/A |