LCD Reference Article Response To Comments Article

Response to Comments: Hyaluronic Acid Injections for Knee Osteoarthritis

A59137

Expand All | Collapse All
Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

Document Note

Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A59137
Original ICD-9 Article ID
Not Applicable
Article Title
Response to Comments: Hyaluronic Acid Injections for Knee Osteoarthritis
Article Type
Response to Comments
Original Effective Date
07/07/2022
Revision Effective Date
N/A
Revision Ending Date
N/A
Retirement Date
N/A

CPT codes, descriptions, and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

Copyright © 2024, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the AHA copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution, or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

N/A

Article Guidance

Article Text

The comment period for the Hyaluronic Acid Injections for Knee Osteoarthritis DL39260 Local Coverage Determination (LCD) began on 3/31/22 and ended on 5/14/22. The notice period for L39260 begins on 7/7/22 and will become effective on 8/21/22. The comment below was received from the provider community.

Response To Comments

Number Comment Response
1

I’ve been a physician for 35 years and I currently own 14 medical practices in 8 States overseen by 4 Medicare Administrative Contractors. All my medical practices do business as Arthritis Knee Pain Centers.

All the medical practices I own focus on treating the pain caused by osteoarthritis of the knee. The CDC recently released a study showing a 30% increase in deaths caused by opioid addiction last year in America. At Arthritis Knee Pain Centers, we treat chronic knee pain caused by osteoarthritis without opioids or surgery. In fact, there are no prescription pads in any of my medical practices.

My medical practices inject FDA-approved Viscosupplement gels into the intraarticular space of the knee, thus cushioning the joint, decreasing the patients’ pain, and increasing their mobility. To ensure the best chance for the procedure to work, my practices inject the Viscosupplement gels with fluoroscopic confirmation of placement. This is similar to what Medicare considers best practice for SI, or sacroiliac joint, injections. The medical literature is clear in its published findings, even experienced physicians miss the intraarticular knee joint space up to 40% of the time without the use of fluoroscopy. Avalere Health performed a study that showed Medicare would save $1.3 B/year if every physician-administered these injections under fluoroscopy, increasing the procedure’s success rate and decreasing the need for total knee replacement surgery. This study is cited in the white paper I wrote about Viscsupplementation (provided for review).

There was a published actuarial study in 2015 by Young in Orthopedics This Week. BC/BS stopped paying for viscosupplementation injections. The following year, knee replacements increased by 498%!

Medicare should revise its LCDs to require fluoroscopic confirmation of placement and make it easier for patients to qualify for this medically necessary treatment.

Reference was provided for review.

Thank you for your comments. We have taken into consideration and reviewed your comments on requiring fluoroscopic confirmation of placement of Viscosupplement injections. The proposed Hyaluronic Acid Injections for Knee Osteoarthritis LCD states under Coverage Indications, Limitations and/or Medical Necessity subheading Limitations “#8. Imaging procedures for the purpose of needle guidance that may be considered reasonable and necessary are ultrasound or fluoroscopy. The documentation must support why imaging is needed for needle guidance and insertion.” We do concur that fluoroscopy is considered reasonable and necessary, however, request documentation to support fluoroscopic imaging.

N/A

Coding Information

Bill Type Codes

Code Description

Please accept the License to see the codes.

N/A

Revenue Codes

Code Description

Please accept the License to see the codes.

N/A

CPT/HCPCS Codes

Please accept the License to see the codes.

N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Additional ICD-10 Information

Bill Type Codes

Code Description

Please accept the License to see the codes.

N/A

Revenue Codes

Code Description

Please accept the License to see the codes.

N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
N/A
Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
N/A

Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related National Coverage Documents
N/A
SAD Process URL 1
N/A
SAD Process URL 2
N/A
Statutory Requirements URLs
N/A
Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
N/A
Other URLs
N/A
Public Versions
Updated On Effective Dates Status
07/01/2022 07/07/2022 - N/A Currently in Effect You are here

Keywords

N/A