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11/20/2012
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Physician
Radiology Tech
Physician Assistant (PA) Nurse Practitioner (NP)
Physical Therapist Lab Tech Nurses
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Source: Novitas Solutions https://www.novitas-solutions.com/policy/jh/l32614-r1.html
Source: Novitas Solutions https://www.novitas-solutions.com/policy/jh/l32614-r1.html
Indications and Limitations of Coverage and/or Medical Necessity
Notice: It is not appropriate to bill Medicare for services that are not covered (as described by this
entire LCD) as if they are covered. When billing for non-covered services, use the appropriate
modifier.
Medicare generally considers vitamin assay panels (more than one vitamin assay) a screening procedure
and therefore, non-covered. Similarly, assays for micronutrient testing for nutritional deficiencies that
include multiple tests for vitamins, minerals, antioxidants and various metabolic functions are never
necessary. Medicare reimburses for covered clinical laboratory studies that are reasonable and necessary
for the diagnosis or treatment of an illness. Many vitamin deficiency problems can be determined from a
comprehensive history and physical examination. Any diagnostic evaluation should be targeted at the
specific vitamin deficiency suspected and not a general screen. Most vitamin deficiencies are nutritional in
origin and may be corrected with supplemented vitamins.
Most vitamin deficiencies are suggested by specific clinical findings. The presence of those specific clinical
findings may prompt laboratory testing for evidence of a deficiency of that specific vitamin. Certain other
clinical states may also lead to vitamin deficiencies (malabsorption syndromes, etc).
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Source: Novitas Solutions https://www.novitas-solutions.com/policy/jh/l32614-r1.html
Limitations:
For Medicare beneficiaries, screening tests are governed by statute (Social Security Act 1861(nn)). Vitamin or
micronutrient testing may not be used for routine screening.
Once a beneficiary has been shown to be vitamin deficient, further testing is medically necessary only to ensure
adequate replacement has been accomplished. Thereafter, annual testing may be appropriate depending upon
the indication and other mitigating factors.
Assays of selenium (84255), functional intracellular analysis (84999) or total antioxidant function (84999) are
non-covered services. Assays of vitamin testing, not otherwise classified (84591), are not covered since all
clinically relevant vitamins have specific assays.
The following are pertinent laboratory tests for which frequency limitations will be specified [note this should be
all the CPT codes in the list below, except for those that are non-covered]:
Vitamins and metabolic function assays: 25-OH Vitamin D-3, Carnitine, Vitamin B-12, Folic Acid (Serum),
Homocystine, Vitamin B-6, Vitamin B-2, Vitamin B-1, Vitamin E, Fibrinogen, High-Sensitivity C-Reactive Protein
and Lipoprotein-associated phospholipase A 2 (Lp-PLA 2); Vitamin A; Vitamin K; and Ascorbic acid.
Source: Novitas Solutions https://www.novitas-solutions.com/policy/jh/l32614-r1.html
82180 Assay of ascorbic acid
82306 Vitamin d 25 hydroxy
82379 Assay of carnitine
82607 Vitamin B-12
82652 Vit d 1 25-dihydroxy
82746 Blood folic acid serum
83090 Assay of homocystine
CPT/HCPCS Codes
Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book. The American
Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) require the use of short
CPT descriptors in policies published on the Web.
Note:
Code 82306 includes fractions, if performed.
Code 82652 includes fractions, if performed.
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Source: Novitas Solutions https://www.novitas-solutions.com/policy/jh/l32614-r1.html
252.00 - 252.02HYPERPARATHYROIDISM, UNSPECIFIED - SECONDARY HYPERPARATHYROIDISM, NON-
RENAL
252.08 OTHER HYPERPARATHYROIDISM
252.1 HYPOPARATHYROIDISM
268.0 RICKETS ACTIVE
268.2 OSTEOMALACIA UNSPECIFIED
268.9 UNSPECIFIED VITAMIN D DEFICIENCY
275.3 DISORDERS OF PHOSPHORUS METABOLISM
275.41 - 275.42 HYPOCALCEMIA - HYPERCALCEMIA
585.3 - 585.6 CHRONIC KIDNEY DISEASE, STAGE III (MODERATE) - END STAGE RENAL DISEASE
ICD-9 Codes that Support Medical Necessity
Note: Providers should continue to submit ICD-9-CM diagnosis codes without decimals on their claim forms and
electronic claims.
The CPT/HCPCS codes included in this LCD will be subjected to “procedure to diagnosis” editing. The following lists
include only those diagnoses for which the identified CPT/HCPCS procedures are covered. If a covered diagnosis is not
on the claim, the edit will automatically deny the service as not medically necessary.
Medicare is establishing the following limited coverage for CPT codes 82306 and 82652:
Covered for:
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http://www.hhs.gov/ocr/privacy/hipaa/enforcement/examples/allcases.html#case1
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http://oig.hhs.gov/fraud/PhysicianEducation/05compliance.asp
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Evaluation and Management Services—Use of Modifiers During the Global Surgery
Period
We will review the appropriateness of the use of certain claims modifier codes during the
global surgery period and determine whether Medicare payments for claims with modifiers
used during such a period were in accordance with Medicare requirements. Prior OIG
work found that improper use of modifiers during the global surgery period resulted in
inappropriate payments. The global surgery payment. includes a surgical service and
related preoperative and postoperative E/M services provided during the global surgery
period. (CMS’s Medicare Claims Processing Manual, Pub. 100-04, ch. 12, § 40.1.)
Guidance for the use of modifiers for global surgeries is in CMS’s Medicare Claims
Processing Manual, Pub. 100-04, ch. 12, § 30.
(OAS; W-00-13-35607; various reviews; expected issue date: FY 2013;
new start) Source: https://oig.hhs.gov/reports-and-publications/archives/workplan/2013/WP01-Mcare_A+B.pdf
Sleep Testing—Appropriateness of Medicare Payments for Polysomnography
We will identify questionable billing patterns for Medicare sleep study services provided in
2009 and 2010. Medicare payments for polysomnography increased from $62 million in
2001 to $235 million in 2009, and coverage was also recently expanded. Sleep studies
are reimbursable for patients who have symptoms such as sleep apnea, narcolepsy, or
parasomnia in accordance with the CMS’s Medicare
Benefit Policy Manual, Pub. 102, ch. 15, § 70.
(OEI; 05-12-00340; expected issue date: FY 2013; work in progress)
Source:https://oig.hhs.gov/reports-and-publications/archives/workplan/2013/WP01-Mcare_A+B.pdf
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