CMS Revises 14 NCDs in Coding Maintenance Update

CMS recently released its seventh maintenance update for National Coverage Determinations (NCD) to incorporate ICD-10 and other coding updates, which may require providers to contact Medicare Administrative Contractors (MAC) regarding previously submitted claims.

The updated NCDs are:

• NCD 90.1, Pharmacogenomic Testing for Warfarin Response
• NCD 110.18, Aprepitant for Chemotherapy-Induced Emesis
• NCD 110.4, Extracorporeal Photopheresis
• NCD 150.3, Bone Mineral Density Studies
• NCD 160.18, Vagus Nerve Stimulation for Treatment of Seizures
• NCD 160.24, Deep Brain Stimulation for Essential Tremor
• NCD 20.29, Hyperbaric Oxygen Therapy
• NCD 20.33, Transcatheter Mitral Valve Repair
• NCD 210.14, Screening for Lung Cancer with Low-Dose CT
• NCD 210.3, Colorectal Cancer Screening Tests
• NCD 220.13, Percutaneous Image-Guided Breast Biopsy
• NCD 220.4, Mammograms
• NCD 230.18, Sacral Nerve Stimulation for Urinary Incontinence
• NCD 260.1, Adult Liver Transplantation

MLN Matters® 9540 includes a link to a spreadsheet outlining the changes made in the latest update. For example, in NCD 110.4, CMS added ICD-10-CM code C84.19 (Sézary disease, extranodal and solid organ sites) as a covered diagnosis effective October 1, 2015.

Providers should look at the changes made and contact their MACs if any previously submitted claims have been impacted erroneously by the changes.

The updates do not include any policy-related updates, which continue to be implemented via the normal NCD process.