Notification of Medical Policy Revisions for September 2023

I. Annual Review: 

   NCD 310.1 

Medicare Managed Care Manual Chp 4 section 10.7 and 10.7.1 

Medicare Benefit Policy Manual Chp 14 section 20 

Medicare Claims Processing Manual Chp 32 section 68 & 69 

Blue Medicare “Evidence of Coverage” (EOC) Chp 3 section 5 

Department of Health and Human Services; CMS; Medicare Learning Network; “Items and Services That Are Not Covered Under the Medicare Program” 

“Medicare and Clinical Research Studies” CMS publication 

US Food and Drug Administration (FDA); Medical Devices 

II. No CMS Updates; Minor Revisions only. Additional references added 

I. Annual Review: 

LCD L33610 

LCD L34580 

LCD L33794 

LCA A52509 

LCA A56718 

Medicare Claims Processing Manual Chp 17 section 80.6 

Medicare Benefit Manual Chp 15 section 50.6 

Medicare Prescription Drug Benefit Manual Chp 6 section 10.2 

CGS: Celerian Group Company News and Publication: Cuvitru-Correct Coding 

II.  No CMS Updates. Verbiage added to reflect LCDs/LCAs. Coding Update: Added J1576 and J1558 per LCD. Added additional ICD 10 diagnosis codes under indications for coverage. Added additional LCD and LCAs to the reference section. 

I. Annual Review 

   NCD 240.1 

II. No CMS Updates. Verbiage added to reflect NCD 

I. Annual Review 

LCD L34552 

Medicare Benefit Policy Manual Chp 6 section 20.6 

II. No CMS Updates. Verbiage added to reflect LCD. Codes added.

I. Annual Review 

BCBSNC Corporate Medical Policy: Myoelectric Prosthetic Components for the Upper Limb 

Medicare Benefit Policy Manual Chp 15 section 110, 120 & 130 

II. Annual Review. No CMS Updates. Additional reference added. Four (4) CPT codes added

I. Annual Review 

LCD L39121 

LCA A58876 

LCD L34536 

LCA A56914 

BCBSNC Corporate Medical Policy: Varicose Veins of the Lower Extremities, Treatment for 

II. No CMS Updates. Verbiage added to reflect NCD. Additional references added

I. Annual Review 

NCD 20.9.1 

Medicare NCA Tracking Sheet for Assist Devices as Destination Therapy CAG-00119N 

Decision Memo for VAD for Bridge to Heart Transplant CAG-00432R 

LCA A53986 

Decision Memo for Artificial Hearts and related Devices, Including VAD for Bridge to Transplant and Destination Therapy CAG-00453N 

NYHA Functional Classification and Outcomes After Transcatheter Mitral Valve Repair in Heart Failure 

II. No CMS Updates. Verbiage added to reflect NCD