You can find out important payment policy indicators such as global surgery days, and bilateral and assistant surgery payment policies for a specific code without having to go out to the Centers for Medicare & Medicaid Services (CMS) website.
Notivas provides these instructions with screen images to help you navigate. Note: The 2015 fees for single-code searches will not be available until January 2015. However, the 2015 fee schedule is available through the Download option.
Medical Policy Updates
These local coverage determinations (LCDs), which Novitas posted for notice on Oct. 9, 2014, are now effective for Jurisdiction H (JH):
Notivas has revised these JH LCDs:
Novitas has added these following JH local coverage articles:
- Routine Foot Care (A51184), and
- Mohs Micrographic Surgery (MMS) (A53852). Note the following:
- Report all surgical procedures performed in the same operative session on the same claim.
- Do not report multiple instances of 17312 and 17314 on separate claim lines. Total the services, and enter the total as a single item with the appropriate number of units of service. These codes refer to the number of blocks, not number of slides.
- If a Mohs procedure is performed on a completely separate lesion on the same date of service, report each first stage (17311 or 17313) code on a separate claim line with modifier 59 signifying a separate and distinct lesion. If additional stages are required on the additional lesion, report the second stage codes (17312 or 17314) on separate claim lines with modifier 59.
- A Clinical Laboratory Improvement Act (CLIA) certification number is required on all claims submitted for Mohs surgery. Submit the CLIA number in item 23 on the CMS-1500 claim form or the electronic equivalent.
This JH local coverage article has been revised: Independent Diagnostic Testing Facility (IDTF) (A53186).
Novitas retired these JH LCDs effective Dec. 3, 2014:
- Category III Codes (L32691),
- Extracorporeal Shock Wave Therapy (ESWT) (L32729),
- Lumbar Matrix Scan (L32609),
- Off Label Use Autologous Cellular Immunotherapy Treatment of Malignancy of Prostate (L32615),
- Routine Foot Care (L32669), and
- Transoral Incisionless Fundoplication (L32620).
Take advantage of the free course, Novitas — Understanding NCDs and LCDs, in the Novitas Medicare Learning Center.
Registration is open for TMA's popular annual Medicare update seminar series. Medicare 2015 is a half-day seminar that runs Feb. 2-Feb. 25 in cities around the state.
Published Dec. 10, 2014
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Last Updated On
December 20, 2016