07/22/2021
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R16
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Under CMS National Coverage Policy updated section headings for regulations. Typographical errors were corrected throughout the LCD.
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- Provider Education/Guidance
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10/24/2019
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R15
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This LCD is being revised in order to adhere to CMS requirements per chapter 13, section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs. There has been no change in coverage with this LCD revision. Regulations regarding billing and coding were removed from the CMS National Coverage Policy section of this LCD and placed in the related Billing and Coding: Respiratory Therapy (Respiratory Care) A56717 article.
At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.
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- Provider Education/Guidance
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07/25/2019
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R14
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All coding located in the Coding Information section has been moved into the related Billing and Coding: Respiratory Therapy (Respiratory Care) A56717 article and removed from the LCD.
All verbiage regarding billing and coding under the Associated Information section has been removed and is included in the related Billing and Coding: Respiratory Therapy (Respiratory Care) A56717 article. Formatting was corrected throughout the LCD.
At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.
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- Provider Education/Guidance
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07/04/2019
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R13
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Under Coverage Indications, Limitations and/or Medical Necessity removed quoted Internet Only Manual (IOM) text and changed verbiage to read “Separate payment is not made for educational instruction (i.e., use of equipment, breathing exercises, etc.) as they are grouped into the covered service”. Under Bibliography changes were made to citations to reflect AMA citation guidelines. Formatting, punctuation and typographical errors were corrected throughout the LCD. Acronyms were inserted and defined where appropriate throughout the LCD.
At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.
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- Provider Education/Guidance
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10/01/2018
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R12
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Under ICD-10 Codes That Support Medical Necessity Group 1: Codes added ICD-10 codes E88.02, G71.00, G71.01, G71.02, and G71.09. This revision is due to the Annual ICD-10 Code Update and becomes effective October 1, 2018.
At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.
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- Provider Education/Guidance
- Revisions Due To ICD-10-CM Code Changes
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07/12/2018
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R11
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Under Coverage Indications, Limitations and/or Medical Necessity added the verbiage “intermittent positive pressure breathing” and placed parentheses around the acronym (IPPB). Under Associated Information – Documentation Requirements added the words “HCPCS codes” in the first paragraph after the bullet points. Under Bibliography added the verbiage “Accessed July 3, 2018” at the end of the first citation and changed the reference pages from 841-845 to 841-851 in the fifth citation. Formatting and punctuation was corrected throughout the policy.
At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.
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01/29/2018
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R10
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The Jurisdiction "J" Part A Contracts for Alabama (10111), Georgia (10211) and Tennessee (10311) are now being serviced by Palmetto GBA. The notice period for this LCD begins on 12/14/17 and ends on 01/28/18. Effective 01/29/18, these three contract numbers are being added to this LCD. No coverage, coding or other substantive changes (beyond the addition of the 3 Part A contract numbers) have been completed in this revision.
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- Change in Affiliated Contract Numbers
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01/01/2018
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R9
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Under CPT/HCPCS Codes Group 1 deleted CPT code 94620. Description was revised for CPT code 94621. This revision is due to the Annual CPT/HCPCS Code Update.
At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.
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- Revisions Due To CPT/HCPCS Code Changes
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10/01/2017
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R8
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Under ICD-10 Codes That Support Medical Necessity deleted ICD-10 codes E85.8 and I27.2 and added E85.81, E85.82, E85.89, G12.23, G12.24, G12.25, I27.20, I27.21, I27.22, I27.23, I27.24, I27.29, I27.83, I50.810, I50.811, I50.812, I50.813, I50.814, I50.82, I50.83, I50.84, I50.89, and R06.03. The code description was revised for I50.1, M33.01 and M33.11. This revision is due to the 2017 Annual ICD-10 Updates.
At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.
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- Provider Education/Guidance
- Revisions Due To ICD-10-CM Code Changes
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12/05/2016
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R7
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Under ICD-10 Codes That Support Medical Necessity- Group 1: Codes added ICD-10 codes G47.31, G47.33, G47.34, G47.35, G47.36, G47.37, and G47.39.
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- Provider Education/Guidance
- Reconsideration Request
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10/03/2016
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R6
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Under ICD-10 Codes That Support Medical Necessity Group 1 added J95.860, J95.861, J95.862, J95.863, J98.51, J98.59, and Z53.32. Under ICD-10 Codes That Support Medical Necessity Group 1 deleted J98.5. This revision is due to the Annual ICD-10 Code Update that becomes effective October 1, 2016.
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- Provider Education/Guidance
- Revisions Due To ICD-10-CM Code Changes
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10/03/2016
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R5
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Under ICD-10 Codes that Support Medical Necessity removed code D86.1 and code range D86.81-D86.89 as these codes are not specific to pulmonary sarcoidosis.
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- Provider Education/Guidance
- Other
- Revisions Due To ICD-10-CM Code Changes
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05/19/2016
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R4
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Under Revenue Codes added revenue code 0460 for reporting pulmonary function tests.
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- Provider Education/Guidance
- Reconsideration Request
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03/24/2016
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R3
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Under CMS National Coverage Policy deleted the following manual reference as it relates to home health services: CMS Internet-Only Manual, Pub 100-02, Medicare Benefit Policy Manual, Chapter 7, §80.8 and deleted CMS Internet-Only Manual and revised the verbiage to now read CMS Manual System as cited on Change Request 6338. Under Coverage Indications, Limitations, and/or Medical Necessity added “of” to the second paragraph. Under ICD-10 Codes That Support Medical Necessity added ICD-10 code J84.9 as requested. Under Associated Information-Documentation Requirements deleted “the” from the last paragraph. Under Sources of Information and Basis for Decision corrected the page numbers for the following journal citation: Taiwo OA, Cain HC. Pulmonary impairment and disability. Clinics in Chest Medicine.
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- Provider Education/Guidance
- Reconsideration Request
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01/01/2016
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R2
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The description changed for CPT code 94640 under the CPT/HCPCS Codes section.
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- Revisions Due To CPT/HCPCS Code Changes
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10/01/2015
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R1
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Under CMS National Coverage Policy added 100-02, Chapter 7, Section 80.8. Under Coverage Indications, Limitations and/or Medical Necessity made a few punctuation corrections. Under Sources of Information and Basis for Decision corrected hyperlink to AARC, removed “describes that the prevalence of dyspnea in the elderly could be as high as 38% and raises the question of how much of this is related to obesity and deconditioning as opposed to actual pulmonary impairments” and “Describes the role of both PFTs and CPET in the evaluation of pulmonary impairments” as these descriptors are incorrectly the source citations.
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- Provider Education/Guidance
- Other (Annual Validation)
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