August Updates to Cahaba Article and LCDs

on Thursday, 03 September 2009. All News Items

In August, Cahaba GBA added an article to the CMS Medicare Articles Database detailing acceptable ICD-9 diagnosis codes for HBO and also updated several LCDs.  Please see the information below from Cahaba with diagnosis code descriptions added by MMP, Inc. for your convenience.  You can access all the Cahaba LCDs and articles at Cahaba LCDs and Articles.

Local Coverage Determination (LCD) UPDATES– J10 MAC A

Effective March 13, 2009, the following LCD update has been made due to FDA approval of a new indication for the use of Zoledronic Acid (Reclast):

Drugs and Biologicals: Zoledronic Acid
For Reclast (J3488):  The “Indications and Limitations” section has been updated to include coverage for glucocorticoid-induced osteoporosis in patients expected to be on glucocorticoids for at least 12 months.

The following ICD-9 code has been added:
733.09 – other osteoporosis


Effective September 1, 2009, the following LCDs have been updated.  Please review the following revisions:

Drugs and Biologicals: Bevacizumab (AVASTIN TM)
The “Indications and Limitations” section has been updated to include coverage for diabetic macular edema, central retinal vein occlusion and venous tributary (branch) occlusion.

For J3590, the following ICD-9 codes have been added:
362.07 – diabetic macular edema
362.35 – central retinal vein occlusion
362.36 – venous tributary (branch) occlusion


Drugs and Biologicals: Oxaliplatin (Eloxatin™)
The “Indications and Limitations” section has been updated to include coverage for the following OFF LABEL indications:

  • Esophageal cancer
  • Pancreatic cancer

The following ICD-9 codes have been added:
150.0-150.5, 150.8, 150.9 – malignant neoplasm of esophagus
157.0-157.9 – malignant neoplasm of pancreasDrugs and Biologicals: Rituximab (Rituxan ®)
The “Indications and Limitations” section has been updated to include coverage for Pemphigus.


 Drugs and Biologicals: Rituximab (Rituxan ®)
The “Indications and Limitations” section has been updated to include coverage for Pemphigus.

The following ICD-9 codes have been added:
694.4 – pemphigus
694.5 – pemphigoid
694.60-694.61 – benign mucous membrane pemphigoid


Surgery: Upper Gastrointestinal Endoscopy
The “Indications and Limitations” section has been updated to include coverage for Helicobacter pylori (H pylori).

The following ICD-9 code has been added:
041.86 – Helicobacter pylori bacterial infection


Article - NCD-Hyperbaric Oxygen Therapy (HBO) (A48900) – J10 MAC A

Effective September 1, 2009, the article NCD-Hyperbaric Oxygen Therapy (HBO) (A48900) has been added to the CMS Medicare Articles Database.  This article outlines the appropriate ICD-9 codes when billing for Hyperbaric Oxygen Therapy (HBO), in accordance with instructions outlined in the Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 1, Section 20.29.

Link to NCD-Hyperbaric Oxygen Therapy (HBO) Article

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