LCDs Selected for JJ Transition

on Tuesday, 09 January 2018. All News Items | Medicare Coverage

Extra, Extra; Read All About It!

In today’s electronic world, do you miss paper? I would have to say both no and yes.  On one hand, it is a relief not to be swimming in a pool of papers that need sorting and filing and storing.  On the other hand, although I love the added conveniences of my electronic reader, I miss the feel and smell of real paper pages. I miss the daily newspaper that had to be spread out across your lap to read. Though I am not that old, I still envision the images of the newspaper boys of the early 1900’s yelling out, “Extra, extra, read all about it!”  In the world of Medicare Administrative Contractors (MACs), the breaking news is the transition of Jurisdiction J (Alabama, Georgia, and Tennessee) from Cahaba GBA to Palmetto GBA. We have known about this for several months now, so even though it is not “new” news anymore, there is still a lot of preparation before the transition dates of January 29th for Part A and February 26th for Part B. 

One important aspect of the JJ transition were the decisions concerning which Local Coverage Determinations (LCDs) to keep, replace, or retire.  Palmetto made their decisions and published a detailed article explaining the rationale for each decision on December 14, 2017.  At the bottom of the article is a link to a crosswalk showing which LCDs were chosen for Part A, Part B, Part AB, and the associated policies not chosen. The spreadsheet also includes tabs for Palmetto LCDs that are new for Jurisdiction J and Cahaba policies that were adopted and are new for providers in Jurisdiction M. All the information providers need to know about the LCD changes can be found in the article and the crosswalk. 

Hospital personnel need to carefully review the new policies related to their areas of interest. Here are a few of the Part A and AB items that caught my attention.

  • The current Palmetto LCD for BNP (B-type natriuretic peptide) was chosen over Cahaba’s LCD. The wording between the two policies is similar but not exactly the same. JJ providers will want to review the new policy carefully. Cahaba has been conducting pre-pay medical review of BNP services with denial rates of 99-100%.
  • Palmetto did not accept Cahaba’s debridement policy because the outpatient OT and PT policies “contain all aspects of care provided by a therapist and ICD-10-CM codes to help providers understand Medicare coverage.”
  • The Palmetto AB policies selected over their Cahaba counterparts include drug testing, facet joint injections, infliximab, rituximab, IVIG, polysomnography, total joint arthroplasty, and others. The Palmetto LCDs for non-covered services incorporated several Cahaba policies that separately addressed non-covered services.
  • Palmetto selected their policies for genetic testing and added a hosts of new genetic testing policies for which Cahaba did not have a counterpart.
  • Overall Palmetto added 67 new LCDs, although 25 of these were the genetic testing policies. Some of the other new policies are for dental services, observation services, one day stays for chest pain, respiratory therapy, cardiac rehab, CT Head, CT chest/thorax, and MRA.
  • From the existing Cahaba policies, Palmetto is adopting, among others, LCDs for partial hospitalization, nerve blocks, and spinal cord stimulators. After transition, these policies will apply to Jurisdiction M as well as to JJ.
  • The current Cahaba policies for hydration therapy, Bevacizumab, Gemcitabine, Oxaliplatin, Zoledronic Acid, and a few others were not adopted by Palmetto so there will not be specific policies for these services after transition.

I have only addressed a small portion of the total LCDs that were adopted so please read Palmetto’s article and crosswalk for complete information. From the crosswalk, it appears after the transition there will be 20 Part A policies, 36 Part B policies, and 47 Parts AB policies for a total of 103 LCDs. That is a lot of reading, on the computer screen or on paper.

Other MAC coverage updates from last month are listed below.

 

Cahaba JJ

No updates this month

 

CGS J15

ID Title Effective Date Revision Effective Date End Date Last Updated Status
A55851  MolDX: ThermoFisher Oncomine Dx Target Test For Non-Small Cell Lung Cancer, Coding and Billing Guidelines  12/1/2017 N/A N/A 12/22/2017 New 

 

First Coast JN

ID Title Effective Date Revision Effective Date End Date Last Updated Status
L33566   Wound Debridement Services  10/1/2015 10/1/2017 12/7/2017 12/7/2017 Retired 

 

NGS J6 and JK

No updates this month

   

Noridian JE

ID Title Effective Date Revision Effective Date End Date Last Updated Status
L37303  MolDX: AlloSure® Donor-Derived Cell-Free DNA Test  12/11/2017 N/A  N/A  10/11/2017 New 
A55653  Parenteral Iron Administration Coverage in Non-Dialysis Usage  1/15/2018 N/A N/A 11/16/2017 New 
A55802  Special Stains and Immunohistochemistry (IHC) Indications for Gastric Pathology  1/1/2018 N/A N/A 11/9/2017 New 

   

Noridian JF

ID Title Effective Date Revision Effective Date End Date Last Updated Status
L37358  MolDX: AlloSure® Donor-Derived Cell-Free DNA Test  12/11/2017 N/A  N/A  10/11/2017 New 
A55734  Parenteral Iron Administration Coverage in Non-Dialysis Usage  1/15/2018 N/A N/A 11/16/2017 New 
A55803  Special Stains and Immunohistochemistry (IHC) Indications for Gastric Pathology  1/1/2018 N/A N/A 11/9/2017 New 

   

Novitas JH and JL

ID Title Effective Date Revision Effective Date End Date Last Updated Status
L35107  Pain Management of Peripheral Nerves by Injection  10/1/2015 10/1/2017 12/1/2017 12/8/2017 Retired 

 

Palmetto JM

No updates this month

 

WPS J5 and J8

No updates this month

 

Article by Debbie Rubio

Debbie Rubio, BS, MT (ASCP), is the Manager of Regulatory Affairs and Compliance at Medical Management Plus, Inc.  Debbie has over twenty-seven years of experience in healthcare including nine years as the Clinical Compliance Coordinator at a large multi-facility health system.  In her current position, Debbie monitors, interprets and communicates current and upcoming regulatory and compliance issues as they relate to specific entities concerning Medicare and other payers.  You may contact Debbie at This email address is being protected from spambots. You need JavaScript enabled to view it..

This material was compiled to share information.  MMP, Inc. is not offering legal advice.  Every reasonable effort has been taken to ensure the information is accurate and useful.

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