The Medicare Monthly Review, MMR-2011-01, January 2011 - CGS

LCD for Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and FundusPhotography) – L25466R6 (effective 01/01/2011) LCD revised for annual 2011 HCPCS update. CPT code 92227 added as anoncovered service (screening) and CPT code 92228 added to the LCD under coverage criteria for fundusphotography.Article for Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and FundusPhotography) – Supplemental Instructions Article (A44439)Article published January 2011: SIA revised for annual 2011 HCPCS update. CPT code 92227 added as anoncovered service (screening) and CPT code 92228 added to the SIA under fundus photographyguidelines sections.Article for Pain Management – Supplemental Instructions Article (A48042)Article published January 2011: HCPCS coding update for 2011. Descriptor changes were made to CPTcodes 20552 and 20553 in Group 1, 20526 in Group 2, 62318 descriptor in Group 3, 64479, 64480, 64483,and 64484 in Group 4, 62318 in Group 5, and 77003 in Group 10. Coding guidelines for EpiduralInjections - Transforaminal were updated as follows: “Effective January 1, 2011 fluoroscopic or computedtomography (CT) image guidance and any injection of contrast are inclusive components of CPT codes64479 – 64484 and should not be separately billed.” Minor changes were made to update for NationalGovernment Services template.LCD for Polysomnography and Sleep Studies (L26428)R7 (effective 01/01/2011): Based on the annual HCPCS update, CPT codes 95800 and 95801 have beenadded to the third paragraph in the “Limitations” section of the LCD, added to the “CPT/HCPCS Codes”section and to the “ICD-9 Codes that Support Medical Necessity” section for sleep studies done due tosleep apnea effective for dates of service on or after 01/01/2011. Minor changes were made to reflectcurrent template language. No notice required and none given.Article for Polysomnography and Sleep Studies – Supplemental Instructions Article (A48396)Article published January 2011: Based on the annual HCPCS update, CPT codes 95800 and 95801 havebeen added to the coding guideline for sleep studies done due to sleep apnea and to the paragraph onunattended sleep studies. These codes have also been added to the fourth paragraph in the CodingGuidelines for claims submitted to the carrier or Part B MAC and to the CPT/HCPC Codes section of theSIA. Minor changes were made to reflect current template language.LCD for Qualitative Drug Screening (L28145)R7 (effective 01/01/2011): Revised for annual 2011 CPT code update. CPT code G0430 was deleted andreplaced with CPT code G0434. Descriptors were changed for CPT code 80100 and HCPCS code G0431.ICD-9 code 305.90 was added to the ICD-9 Codes that Support Medical Necessity. Minor changes madeto update for National Government Services and CMS template changes. No notice given and nonerequired.Article for Qualitative Drug Screening – Supplemental Instructions Article (A48395)Article published January 2011: Revised for annual 2011 CPT code update. CPT code G0430 was deletedand replaced with CPT code G0434. Descriptors were changed for CPT code 80100 and HCPCS codeG0431. The following statement was added the “Specific coding guidelines for this policy: “For dates ofservice on, or after 01/01/2011, append modifier QW to G0434 to indicate a CLIA waived test.” for claimssubmitted to the carrier or Part B MAC. Minor changes made to update for National GovernmentServices and CMS template changes.CPT codes and descriptors are only copyright 2010 American Medical Association (or such other date publication of CPT)The Medicare Monthly Review 16 MMR 2011-01, January 2011