Local Coverage Determination (LCD)

Transcatheter Infusion Therapy

L34084

Expand All | Collapse All
Proposed LCD
Proposed LCDs are works in progress that are available on the Medicare Coverage Database site for public review. Proposed LCDs are not necessarily a reflection of the current policies or practices of the contractor.

Document Note

Note History

Contractor Information

LCD Information

Document Information

Source LCD ID
N/A
LCD ID
L34084
Original ICD-9 LCD ID
Not Applicable
LCD Title
Transcatheter Infusion Therapy
Proposed LCD in Comment Period
N/A
Source Proposed LCD
N/A
Original Effective Date
For services performed on or after 10/01/2015
Revision Effective Date
For services performed on or after 09/05/2024
Revision Ending Date
N/A
Retirement Date
N/A
Notice Period Start Date
N/A
Notice Period End 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.

Issue

Issue Description

This LCD outlines limited coverage for this service with specific details under Coverage Indications, Limitations, and/or Medical Necessity.

Issue - Explanation of Change Between Proposed LCD and Final LCD

CMS National Coverage Policy

Language quoted from Centers for Medicare and Medicaid Services (CMS). National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in interpretive manuals are not subject to the Local Coverage Determination (LCD) Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See Section 1869(f)(1)(A)(i) of the Social Security Act.

Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources:

Title XVIII of the Social Security Act (SSA):

Section 1862(a)(1)(A) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Section 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

CMS Publications:

CMS Pub. 100-02 Medicare Benefit Policy Manual, Chapter 15:

    Section 50:coverage criteria for drugs and biologicals, administered incident to a physician service.

Coverage Guidance

Coverage Indications, Limitations, and/or Medical Necessity

Abstract:

For the purpose of this LCD, Transcatheter Therapy is defined as the infusion of medication (other than chemotherapy and thrombolysis) through an inserted arterial (angiographic) catheter for the purpose of delivering specific medication to a localized vascular bed. Therapeutic infusion of medications is covered for indications identified in the LCD, when other routes of administration are not appropriate or effective. The treatment is reimbursable as a single service, regardless of the duration of the infusion.

Indications:

Transcatheter infusion therapy is indicated for the prolonged therapeutic administration (infusion) of a medication through a previously inserted arterial angiographic catheter for the purpose of delivering the medication to an individual vascular bed. Such administration assumes that the drug could not be delivered effectively via any other route (e.g., sublingual, intravenous, intramuscular, subcutaneous, etc) and must be infused via the indwelling catheter to be effective.

Infusion is defined as the prolonged, continuous administration of the medication through the catheter lasting a minimum of 30 minutes. It may require the use of an infusion pump. Bolus, "push" or "slow push" injections are not infusions.

Transcatheter infusions may be indicated for the treatment of:

  • cerebrovasospasm
  • bleeding involving the head or neck
  • gastrointestinal hemorrhage
  • non-occlusive mesenteric ischemia.
  • Raynaud's syndrome
  • Medications for which infusion is a reimbursable service include:
    • nitroglycerin (for cerebrovascular spasm, only)
    • neosynephrine
    • vasopressin
    • somatastatin
    • papaverine
    • reserpine

Limitations:

Transcatheter administration of medications or other biologics for reasons other than treatment (e.g., medications administered for diagnostic purposes; contrast agents administered for imaging) and medications administered incidental to a diagnostic procedure, albeit for therapeutic reasons (e.g., nitroglycerin administered intra-coronary during coronary angiography), are not covered or reimbursable under this code.

CPT codes for transcatheter infusion therapy is reimbursable only once per encounter, regardless of the number of medications infused or duration of the infusion beyond 30 minutes.

Infusions for the treatment of primary pulmonary hypertension are considered investigational and will be denied as not medically necessary.

Infusions for medications normally given by bolus or "push" technique or by another route will be denied as not medically necessary.


Summary of Evidence

N/A

Analysis of Evidence (Rationale for Determination)

N/A

Proposed Process Information

Synopsis of Changes
Changes Fields Changed
N/A
Associated Information
Sources of Information
Bibliography
Open Meetings
Meeting Date Meeting States Meeting Information
N/A
Contractor Advisory Committee (CAC) Meetings
Meeting Date Meeting States Meeting Information
N/A
MAC Meeting Information URLs
N/A
Proposed LCD Posting Date
Comment Period Start Date
Comment Period End Date
Reason for Proposed LCD
Requestor Information
This request was MAC initiated.
Requestor Name Requestor Letter
View Letter
N/A
Contact for Comments on Proposed LCD

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

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

Additional ICD-10 Information

General Information

Associated Information
N/A
Sources of Information
N/A
Bibliography

N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation Reasons for Change
09/05/2024 R16

R16

Revision Effective: 09/05/2024

Revision Explanation: Annual review, no changes were made.

08/26/2024: 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.

  • Other (Annual Review )
09/07/2023 R15

R15

Revision Effective: 09/07/223

Revision Explanation: Annual review, removed information from general information section. 

08/31/223: 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.

  • Other (Annual Review)
09/01/2022 R14

R14

Revision Effective: 09/01/2022

Revision Explanation: Annual review, no changes were made.

08/26/2022: 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.

  • Other (Annual Review)
08/19/2021 R13

R13

Revision Effective: 08/19/2021

Revision Explanation: Annual review, no changes were made.

08/10/2021: 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.

  • Other (Annual Review)
12/05/2019 R12

R12

Revision Effective: n/a

Revision Explanation: Annual review, no changes made

08/25/2020: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.

  • Other (Annual Review)
12/05/2019 R11

R11

Revision Effective: 12/05/2019

Revision Explanation: Moved the other comments and associated documentation information and placed into the billing and coding article.

11/27/2019: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.

  • Provider Education/Guidance
09/26/2019 R10

R10

Revision Effective: 09/26/2019

Revision Explanation: Annual review, no changes made.

09/23/2019: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.

  • Other (Annual review, no changes made)
09/26/2019 R9

R9

Revision Effective: 09/26/2019 Revision Explanation: Converted to new policy template that no longer includes coding section based on CR 10901.Also, retired Transcatheter Infusion Therapy-Supplemental Instructions Article.

09/20/2019: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.

  • Revisions Due To Code Removal
10/01/2018 R8

R8

Revision Effective: N/A

Revision Explanation: Annual review no changes made.

DATE (08/27/2019): 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.

  • Other (Annual Review)
10/01/2018 R7

R7

Revision Effective: 10/01/2018

Revision Explanation: During annual ICD-10 review new codes I67.850 and I67.858 were added to group 1.

DATE (09/21/2018): 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.

  • Revisions Due To ICD-10-CM Code Changes
10/01/2016 R6

R6

Revision Effective: N/A

Revision Explanation: Annual review no changes made.

DATE (08/13/2018): 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.

  • Other (Annual Review)
10/01/2016 R5

R5

Revision Effective: N/A

Revision Explanation: Annual review no changes made.

DATE (08/28/2017): 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.


 

  • Other (Annual review)
10/01/2016 R4 R4
Revision Effective: 10/01/2016
Revision Explanation: During annual ICD-10 update I60.21, I60.22, and K55.0 were deleted and replaced with the following: I60.2, K55.011, K55.012, K55.019, K55.021, K55.022, K55.029, K55.031, K55.032, K55.039, K55.041, K55.042, K55.049, K55.051, K55.052, K55.019.
  • Revisions Due To ICD-10-CM Code Changes
01/01/2016 R3 R3
Revision Effective: 01/01/2016
Revision Explanation: In limitations section of text the following sentence still referenced CPT 3720. This was corrected to reflect the current codes.
CPT code 37202 is reimbursable only once per encounter, regardless of the number of medications infused or duration of the infusion beyond 30 minutes.
  • Typographical Error
01/01/2016 R2 R2
Revision Effective: 01/01/2016
Revision Explanation: Added 61650 and 61651 that are new for 2016. These codes replaced deleted code 37202.
  • Revisions Due To CPT/HCPCS Code Changes
10/01/2015 R1 R1
Revision Effective: N/A
Revision Explanation: Accepted revenue code description changes.
  • Other (Revenue code description code changes)
N/A

Associated Documents

Attachments
N/A
Related Local Coverage Documents
Articles
A56811 - Billing and Coding: Transcatheter Infusion Therapy
Related National Coverage Documents
N/A
Public Versions
Updated On Effective Dates Status
08/26/2024 09/05/2024 - N/A Currently in Effect You are here
08/31/2023 09/07/2023 - 09/04/2024 Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

N/A

Read the LCD Disclaimer