Automated Medical Review 


You could download from the below link.


http://medicare.fcso.com/wrapped/274350.zip

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