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April 2018 Revised LCDs and Articles

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April 2018 Revised LCDs and Articles

Hyaluronans Intra-articular Injections of – Related to LCD L33394 (A52420)

Based on Transmittal 3988 – April 2018 Update of the Hospital Outpatient Prospective Payment System (OPPS), HCPCS code C9465 has been added effective for dates of service on or after 4/1/2018. HCPCS code J3490 should be used to report Durolane® when billed to the Part B MAC. Durolane® has been added throughout the article.

Infliximab, Infliximab-dyyb, Infliximab-abda (e.g., Remicade™, Inflectra™, Renflexis) – Related to LCD L33394 (A52423)

Based on Transmittal 3966 – Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes – April 2018 Update, HCPCS code Q5102 has been deleted and replaced with HCPCS codes Q5103 and Q5104 and use of modifiers ZB and ZC have been discontinued effective for dates of service on or after 4/1/2018.

Based on a practitioner request, ICD-10-CM codes M54.31, M54.32, M54.41 and M54.42 were added to Group 1 in the “ICD-10-CM Codes that Support Medical Necessity” section for dates of service on or after 10/1/2017.

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Update from the Chairman

In my last update, I shared that our new 2019 Membership … Read moreUpdate from the Chairman