Automated World Health
Local Coverage Determination (LCD) for Cardiac Output Monitoring By Thoracic
Electrical Bioimpedance (L28793)
Contractor Information
Contractor Name First Coast Service Options, Inc.
Contractor Number 09101
Contractor Type MAC - Part A
LCD Information
Document Information
LCD ID Number L28793
LCD Title Cardiac Output Monitoring By Thoracic Electrical Bioimpedance
Contractor's Determination Number A93701
Primary Geographic Jurisdiction Florida
Oversight Region Region IV
AMA CPT/ADA CDT Copyright Statement
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Original Determination Effective Date
For services performed on or after 02/16/2009 Original Determination Ending Date
Revision Effective Date
For services performed on or after 10/01/2011 Revision Ending Date
CMS National Coverage Policy
Language quoted from CMS National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals are italicized throughout the Local Coverage Determination (LCD). NCDs and coverage provisions in interpretive manuals are not subject to the LCD Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See §1869(f)(1)(A)(i) of the Social Security Act.
Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources: CMS Manual System, Pub. 100-03 Medicare National Coverage Determinations, Chapter 1, section 20-16
Indications and Limitations of Coverage and/or Medical Necessity
Cardiac output monitoring using electrical bioimpedance, a form of plethysmography, is covered by Medicare effective for services furnished on or after July 1, 1999.
These devices utilize electrical bioimpedance to noninvasively produce hemodynamic measurements of cardiac output, specifically stroke volume, contractility, systemic vascular resistance, and thoracic fluid content. These devices are covered for the following indications:
• Differentiation of cardiogenic from pulmonary causes of acute dyspnea when medical history, physical examination, and standard assessment tools provide insufficient information, and the treating physician has determined that TEB hemodynamic data are necessary for appropriate management of the patient.
• Optimization of atrioventricular (A/V) interval for patients with A/V sequential cardiac pacemakers when medical history, physical examination, and standard assessment tools provide insufficient information, and the treating physician has determined that TEB hemodynamic data are necessary for appropriate management of the patient.
• Monitoring of continuous inotropic therapy for patients with terminal congestive heart failure, when those patients have chosen to die with comfort at home, or for patients waiting at home for a heart transplant.
• Evaluation for rejection in patients with a heart transplant as a predetermined alternative to a myocardial biopsy. Medical necessity must be documented should a biopsy be performed after TEB.
• Optimization of fluid management in patients with congestive heart failure when medical history, physical examination, and standard assessment tools provide insufficient information, and the treating physician has determined that TEB hemodynamic data are necessary for appropriate management of the patient.
• Management of drug-resistant hypertension. Drug resistant hypertension is defined as failure to achieve goal BP in patients who are adhering to full doses of an appropriate three-drug regimen that includes a diuretic.
The following are examples of appropriate clinical indications for which Medicare will consider the assessment of cardiac output by electrical bioimpedance medically reasonable and necessary:
• For patients with structural heart disease (with an ejection fraction < 40%) associated with the development of congestive heart failure (e.g., valvular and congenital, post myocardial infarction, rheumatic heart disease);
• For patients with inflammatory heart disease (with an ejection fraction < 40%) associated with the development of congestive heart failure (e.g., myocarditis and cardiomyopathy, pericarditis and constrictive pericardial scarring, rheumatic heart disease);
• For patients with ischemic heart disease (with an ejection fraction < 40%) associated with the development of congestive heart failure (e.g., post myocardial infarction, ischemic cardiomyopathy, ischemic mitral valve or left ventricular dysfunction);
• For patients with cardiac disease resulting in congestive heart failure with normal left ventricular function (e.g., diastolic dysfunction, restrictive cardiomyopathy/infiltrative such as amyloidosis or cancer of the heart);
• For patients with pulmonary disease associated with congestive heart failure (e.g., cor pulmonale and the need to distinguish between pulmonary and cardiac disease as the cause, pulmonary hypertension);
• For acute conditions for which the patient might present to an outpatient setting and in which a decision regarding intervention is necessary (e.g., pericardial effusion with possible tamponade, myocardial infarction, cardiac trauma);
• For patients with recent pacemaker implants who demonstrate clinical manifestations of unexplained fatigue, symptomatic hypotension, or congestive heart failure;
• For the titration of therapeutic agents in the setting of symptomatic congestive heart failure;
• For acute heart rejection during outpatient follow-up of heart transplant patients (as a supplement to invasive endomyocardial biopsy); and/or
• For patients with acute/chronic renal failure or end stage renal disease/dialysis who demonstrate clinical manifestations of unexplained shortness of breath, unexplained reduced access flow, symptomatic hypotension/hypertension.
LIMITATIONS OF COVERAGE
Cardiac output by electrical bioimpedance is not covered for the following indications:
• Monitoring of patients with proven or suspected disease involving severe regurgitation of the aorta;
• Patients with minute ventilation (MV) sensor function pacemakers (since the device may adversely affect the functioning of that type of pacemaker);
• Cardiac bypass patients while on a cardiopulmonary bypass machine (since the device does not render accurate measurements under this circumstance);
• The use of electrical bioimpedance for the routine assessment of hypertensive patients.
Coding Information
Bill Type Codes:
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
012x Hospital Inpatient (Medicare Part B only) 013x Hospital Outpatient
014x Hospital - Laboratory Services Provided to Non-patients 021x Skilled Nursing - Inpatient (Including Medicare Part A) 072x Clinic - Hospital Based or Independent Renal Dialysis Center 085x Critical Access Hospital
Revenue Codes:
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.
0920 Other Diagnostic Services - General Classification 0940 Other Therapeutic Services - General Classification
CPT/HCPCS Codes
93701 BIOIMPEDANCE-DERIVED PHYSIOLOGIC CARDIOVASCULAR ANALYSIS
ICD-9 Codes that Support Medical Necessity
391.0 - 391.9 ACUTE RHEUMATIC PERICARDITIS - ACUTE RHEUMATIC HEART DISEASE UNSPECIFIED
394.0 - 394.9 MITRAL STENOSIS - OTHER AND UNSPECIFIED MITRAL VALVE DISEASES
397.0 - 397.9 DISEASES OF TRICUSPID VALVE - RHEUMATIC DISEASES OF ENDOCARDIUM VALVE UNSPECIFIED
398.90 RHEUMATIC HEART DISEASE UNSPECIFIED
398.91 RHEUMATIC HEART FAILURE (CONGESTIVE)
401.0 MALIGNANT ESSENTIAL HYPERTENSION
401.9 UNSPECIFIED ESSENTIAL HYPERTENSION
402.00 - 402.01 MALIGNANT HYPERTENSIVE HEART DISEASE WITHOUT HEART FAILURE - MALIGNANT HYPERTENSIVE HEART DISEASE WITH HEART FAILURE
402.11 BENIGN HYPERTENSIVE HEART DISEASE WITH HEART FAILURE
402.91 UNSPECIFIED HYPERTENSIVE HEART DISEASE WITH HEART FAILURE
403.00 - 403.01 HYPERTENSIVE CHRONIC KIDNEY DISEASE, MALIGNANT, WITH CHRONIC KIDNEY DISEASE STAGE I THROUGH STAGE IV, OR UNSPECIFIED - HYPERTENSIVE CHRONIC KIDNEY DISEASE, MALIGNANT, WITH CHRONIC KIDNEY DISEASE STAGE V OR END STAGE RENAL DISEASE
403.11 HYPERTENSIVE CHRONIC KIDNEY DISEASE, BENIGN, WITH CHRONIC KIDNEY DISEASE STAGE V OR END STAGE RENAL DISEASE
403.91 HYPERTENSIVE CHRONIC KIDNEY DISEASE, UNSPECIFIED, WITH CHRONIC KIDNEY DISEASE STAGE V OR END STAGE RENAL DISEASE HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, MALIGNANT, WITHOUT HEART
404.00 - 404.03 FAILURE AND WITH CHRONIC KIDNEY DISEASE STAGE I THROUGH STAGE IV, OR UNSPECIFIED - HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, MALIGNANT, WITH HEART FAILURE AND WITH CHRONIC KIDNEY DISEASE STAGE V OR END STAGE RENAL DISEASE
404.11 HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, BENIGN, WITH HEART FAILURE AND WITH CHRONIC KIDNEY DISEASE STAGE I THROUGH STAGE IV, OR UNSPECIFIED
404.12 HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, BENIGN, WITHOUT HEART FAILURE AND WITH CHRONIC KIDNEY DISEASE STAGE V OR END STAGE RENAL DISEASE
404.13 HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, BENIGN, WITH HEART FAILURE AND CHRONIC KIDNEY DISEASE STAGE V OR END STAGE RENAL DISEASE
HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, UNSPECIFIED, WITH HEART
404.91 FAILURE AND WITH CHRONIC KIDNEY DISEASE STAGE I THROUGH STAGE IV, OR UNSPECIFIED
404.92 HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, UNSPECIFIED, WITHOUT HEART FAILURE AND WITH CHRONIC KIDNEY DISEASE STAGE V OR END STAGE RENAL DISEASE
404.93 HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, UNSPECIFIED, WITH HEART FAILURE AND CHRONIC KIDNEY DISEASE STAGE V OR END STAGE RENAL DISEASE
405.01 - 405.09 MALIGNANT RENOVASCULAR HYPERTENSION - OTHER MALIGNANT SECONDARY HYPERTENSION
405.91 - 405.99 UNSPECIFIED RENOVASCULAR HYPERTENSION - OTHER UNSPECIFIED SECONDARY HYPERTENSION
410.00 - 410.92 ACUTE MYOCARDIAL INFARCTION OF ANTEROLATERAL WALL EPISODE OF CARE UNSPECIFIED - ACUTE MYOCARDIAL INFARCTION OF UNSPECIFIED SITE SUBSEQUENT EPISODE OF CARE
411.0 - 411.89 POSTMYOCARDIAL INFARCTION SYNDROME - OTHER ACUTE AND SUBACUTE FORMS OF ISCHEMIC HEART DISEASE OTHER
413.0 - 413.9 ANGINA DECUBITUS - OTHER AND UNSPECIFIED ANGINA PECTORIS
414.00 - 414.07 CORONARY ATHEROSCLEROSIS OF UNSPECIFIED TYPE OF VESSEL NATIVE OR GRAFT - CORONARY ATHEROSCLEROSIS OF BYPASS GRAFT (ARTERY) (VEIN) OF TRANSPLANTED HEART
414.10 - 414.19 ANEURYSM OF HEART (WALL) - OTHER ANEURYSM OF HEART
414.4 CORONARY ATHEROSCLEROSIS DUE TO CALCIFIED CORONARY LESION
414.8 OTHER SPECIFIED FORMS OF CHRONIC ISCHEMIC HEART DISEASE
415.0 - 415.19 ACUTE COR PULMONALE - OTHER PULMONARY EMBOLISM AND INFARCTION
420.0 - 420.99 ACUTE PERICARDITIS IN DISEASES CLASSIFIED ELSEWHERE - OTHER ACUTE PERICARDITIS ACUTE AND SUBACUTE BACTERIAL ENDOCARDITIS - ACUTE ENDOCARDITIS UNSPECIFIED
421.0 ACUTE AND SUBACUTE BACTERIAL ENDOCARDITIS
421..1 ACUTE AND SUBACUTE INFECTIVE ENDOCARDITIS IN DISEASES CLASSIFIED ELSEWHERE
421.9 ACUTE ENDOCARDITIS UNSPECIFIED
422.0 ACUTE MYOCARDITIS IN DISEASES CLASSIFIED ELSEWHERE
422.90 ACUTE MYOCARDITIS UNSPECIFIED
422.91 IDIOPATHIC MYOCARDITIS
422.92 SEPTIC MYOCARDITIS
422.93 TOXIC MYOCARDITIS
422.99 OTHER ACUTE MYOCARDITIS
423.0 HEMOPERICARDIUM
423.1 ADHESIVE PERICARDITIS
423.2 CONSTRICTIVE PERICARDITIS
423.3 CARDIAC TAMPONADE
423.8 OTHER SPECIFIED DISEASES OF PERICARDIUM
423.9 UNSPECIFIED DISEASE OF PERICARDIUM
424.0 MITRAL VALVE DISORDERS
424.2 TRICUSPID VALVE DISORDERS SPECIFIED AS NONRHEUMATIC
424.3 PULMONARY VALVE DISORDERS
424.90 ENDOCARDITIS VALVE UNSPECIFIED UNSPECIFIED CAUSE
424.91 ENDOCARDITIS IN DISEASES CLASSIFIED ELSEWHERE
424.99 OTHER ENDOCARDITIS VALVE UNSPECIFIED
425.0 ENDOMYOCARDIAL FIBROSIS
425.11 HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY
425.18 OTHER HYPERTROPHIC CARDIOMYOPATHY
425.2 OBSCURE CARDIOMYOPATHY OF AFRICA
425.3 ENDOCARDIAL FIBROELASTOSIS
425.4 OTHER PRIMARY CARDIOMYOPATHIES
425.5 ALCOHOLIC CARDIOMYOPATHY
425.7 NUTRITIONAL AND METABOLIC CARDIOMYOPATHY
425.8 CARDIOMYOPATHY IN OTHER DISEASES CLASSIFIED ELSEWHERE
428.0 CONGESTIVE HEART FAILURE UNSPECIFIED
428.1 LEFT HEART FAILURE
428.20 UNSPECIFIED SYSTOLIC HEART FAILURE
428.21 ACUTE SYSTOLIC HEART FAILURE
428.22 CHRONIC SYSTOLIC HEART FAILURE
428.23 ACUTE ON CHRONIC SYSTOLIC HEART FAILURE
428.30 UNSPECIFIED DIASTOLIC HEART FAILURE
428.31 ACUTE DIASTOLIC HEART FAILURE
428.32 CHRONIC DIASTOLIC HEART FAILURE
428.33 ACUTE ON CHRONIC DIASTOLIC HEART FAILURE
428.40 UNSPECIFIED COMBINED SYSTOLIC AND DIASTOLIC HEART FAILURE
428.41 ACUTE COMBINED SYSTOLIC AND DIASTOLIC HEART FAILURE
428.42 CHRONIC COMBINED SYSTOLIC AND DIASTOLIC HEART FAILURE
428.43 ACUTE ON CHRONIC COMBINED SYSTOLIC AND DIASTOLIC HEART FAILURE
428.9 HEART FAILURE UNSPECIFIED
429.3 CARDIOMEGALY
429.4 FUNCTIONAL DISTURBANCES FOLLOWING CARDIAC SURGERY
429.83 TAKOTSUBO SYNDROME
430 SUBARACHNOID HEMORRHAGE
518.4 ACUTE EDEMA OF LUNG UNSPECIFIED
518.7 TRANSFUSION RELATED ACUTE LUNG INJURY (TRALI)
786.05 SHORTNESS OF BREATH
996.83 COMPLICATIONS OF TRANSPLANTED HEART
V42.1* HEART REPLACED BY TRANSPLANT
V53.31 FITTING AND ADJUSTMENT OF CARDIAC PACEMAKER
V53.32 FITTING AND ADJUSTMENT OF AUTOMATIC IMPLANTABLE CARDIAC DEFIBRILLATOR
* According to the ICD-9-CM book, diagnosis code V42.1 is a secondary diagnosis code and should not be billed as the primary diagnosis.
Diagnoses that Support Medical Necessity N/A
ICD-9 Codes that DO NOT Support Medical Necessity N/A
XX000 Not Applicable
ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation
Diagnoses that DO NOT Support Medical Necessity N/A
General Information
Documentations Requirements
Medical record documentation (e.g., office/progress notes) maintained by the ordering/referring physician must indicate the medical necessity for assessment of cardiac output by electrical bioimpedance.
Additionally, a copy of the measurements acquired through the use of the electrical bioimpedance device, with the physician's signature, must be maintained in the medical record.
Appendices
Utilization Guidelines The frequency of measurements of cardiac output monitoring by thoracic electrical bioimpedance which Medicare will consider medically reasonable and necessary will be based on the purpose for which the measurement is obtained. The following are examples of categories of use and the general guidelines regarding measurement frequency:
Diagnostic - Frequency of use for diagnostic purposes will apply to patients in whom congestive heart failure is evident, yet its etiology is unclear. An initial measurement may be sufficient, with infrequent follow-up assessments. Examples include (but are not limited to):
- A patient with respiratory failure and the need to distinguish the presence of a cardiac component of the illness.
- Pericardial effusion of uncertain hemodynamic significance.
- Suspected diastolic dysfunction or the presence of congestive heart failure in the setting of normal left ventricular function.
Titration of Therapeutic Agents - Frequency of use for monitoring therapeutic drug response will require more frequent measurements, and may vary. The frequency at which titration of the therapeutic agents is considered medically reasonable and necessary will be based on whether the drug is approved for use in a regimented fashion. Examples include (but are not limited to):
- Medication adjustments in patients with refractory congestive heart failure due to either systolic or diastolic dysfunction (especially patients with a left ventricular ejection fraction < 40%).
- Medication adjustments for patients receiving a hemodynamically active anti-hypertensive medication for which a regimented or standardized approach exists. Weekly assessments may be considered reasonable in patients undergoing titration of medications for which there is a regimented approach to titration (e.g., carvedilol).
Because individual tolerance is quite variable and the side effects make it difficult to ascertain whether the patient is realizing maximal benefit, knowledge of the cardiac output as an objective measure would assist the practitioner in decisions regarding titration. ACE inhibitors may also fall into this category, yet a maximum of 4 to 6 weekly measurements may be sufficient, with subsequent measurements at 1-3 month intervals.
Monitoring - Frequency of use for monitoring of a patient for a period of clinical assessment should be thought of as a single use. Examples include:
• To determine the effect of changes in pacemaker programming where several adjustments might be made during a single visit to optimize pacemaker function.
• Hemodynamic monitoring during a surgical procedure that takes place in the physician's office.
NOTE: Measurement of cardiac output monitoring by thoracic electrical bioimpedance is not considered medically reasonable and necessary upon each visit or for each change in the patient's medication regimen.
Sources of Information and Basis for Decision
Drazner MH, et al. Comparison of impedance cardiography with invasive hemodynamic measurements in patients with heart failure secondary to ischemia of nonischemic cardiomyopathy. Amer J Cardiol 2002 Apr 15;18(8):993- 5.
Gilbert J, Lazio L.; Managing congestive heart failure with thoracic electrical bioimpedance.,: AACN Clin Issues 1999 Aug;10(3):400-5
Hartleb M, Rudzki K, Waluga M, Janusz M, Karpel E.; Usefulness of thoracic electrical bioimpedance in detection of ejection fraction changes., J Physiol Pharmacol 2000 Mar;51(1):151-9
Hirschl MM, Kittler H, Woisetschlager C, Siostrzonek P, Staudinger T, Kofler J, Oschatz E, Bur A, Gwechenberger M, Laggner AN.; Simultaneous comparison of thoracic bioimpedance and arterial pulse waveform-derived cardiac output with thermodilution measurement., Crit Care Med 2000 Jun;28(6):1798-802
Imhoff M, et al. Noninvasive whole-body electrical bioimpedance cardiac output and invasive thermodilution cardiac output in high-risk surgical patients. Crit Care Med 2000 Aug; 28(8):2812-8.
Jordan HS, Ioannidis JPA, Goudas LC, et al. and the Tufts-New England Medical Center AHRQ Evidence-based Practice Center. Thoracic electrical bioimpedance. EPC Technical Support of the CPTA Technology Assessment Program. Contract No. 290-97-0019, Task Order #10. Rockville, MD: AHRQ; revised November 27, 2002.
Available at: http://www.cms.hhs.gov/mcd/viewtechassess.asp?id=23 . Accessed October 3, 2003.
Kosowsky JM, et al. Assessment of stroke index using impedance cardiography: comparison with traditional vital signs for detection of moderate acute loss of blood in healthy volunteers. Acad Emerg Med 2002 Aug;9(8):775- 80.
Lasater, R.N., MSN, CCRN, M. (1998). The view within: The emerging technology of thoracic electrical bioimpedance. Critical Care Nursing Quarterly, 21 (3), 97-101.
Marrocco, A., Eskin, B., Nashed, A., et al. (1998). Noninvasive bioimpedance monitoring differentiates cardiogenic from pulmonary causes of acute dyspnea in the emergency department. SAEM 1998 Annual Meeting Academic Emergency Medicine, 5 (5), 476-477.
Milzman, D., Hogan, C., Zlindenny, A., et al. (1998). The utility of thoracic impedance to evaluate chest radiograph changes from acute heart failure patients in the emergency department. Journal of Cardiac Failure, 4 (3), Supplement 1.
Nakonezny PA, et al. New ambulatory impedance cardiograph validated against Minnesota Impedance Cardiograph. Psychophysiol 2001 May;38:465-73.
1999 World Health Organization-International Society of Hypertension guidelines for the management of hypertension. Guidelines Subcommittee. Journal of Hypertension, 17 (2), 151-183.
Sageman WS, et al. Equivalence of bioimpedance and thermodilution in measuring cardiac index after cardiac surgery. J Cardiothorac Vas Anesth 2002 Feb;16(1):8-14.
Spiess BD, et al. Comparison of bioimpedance versus thermodilution cardiac output during cardiac surgery; evaluation of a second generation bioimpedance device. J Cardiothorac Vasc Anesth 2001;15(5):567-73.
U.S. Department of Health and Human Services, Center for Medicare and Medicaid Services (CMS). Decision memo for electrical bioimpedance for cardiac output monitoring (CAG-00001R). Medicare Coverage Database. Baltimore, MD: CMS; August 7, 2003. http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=23 . Accessed October 3, 2003.
Zaluska W, Jaroszynski A, Bober E, Malecka T, Kozik J, Ksiazek A.; [Measurement of fluid compartments using electrical bioimpedance for assessment of target weight in hemodialysis patients], Przegl Lek 2000;57(12):707- 10
1999 World Health Organization-International Society of Hypertension guidelines for the management of hypertension. Guidelines Subcommittee. Journal of Hypertension, 17 (2), 151-183.
Advisory Committee Meeting Notes This policy does not reflect the sole opinion of the contractor or contractor medical director. Although the final decision rests with the contractor, this policy was developed in cooperation
with advisory groups, which includes representatives from Florida Chapter, American College of Cardiology.
Start Date of Comment Period
End Date of Comment Period
Start Date of Notice Period 01/01/2010
Revision History Number 2
Revision History Explanation Revision Number: 2 Start Date of Comment Period:N/A
Start Date of Notice Period:10/01/2011 Revised Effective Date:10/01/2011
LCR A2011-078
September 2011 Connection
Explanation of Revision: Annual 2012 ICD-9-CM Update. Added diagnosis code 414.4. The effective date of this revision is based on date of service.
Revision Number:1
Start Date of Comment Period:N/A Start Date of Notice Period:01/01/2010 Revised Effective Date: 01/01/2010
LCR A2010 - 007
December 2009 Bulletin
Explanation of Revision: Annual 2010 HCPCS Update. Revised descriptor for CPT code 93701. The effective date of this revision is based on date of service.
Revision Number: Original
Start Date of Comment Period: N/A Start Date of Notice Period: 12/04/2008 Original Effective Date: 02/16/2009
This LCD consolidates and replaces all previous policies and publications on this subject by the fiscal intermediary predecessors of First Coast Service Options, Inc. (COSVI and FCSO).
For Florida (00090) this LCD (L28793) replaces LCD L1417 as the policy in notice. This document (L28793) is effective on 02/16/2009.
11/15/2009 - The description for CPT/HCPCS code 93701 was changed in group 1 8/1/2010 - The description for Bill Type Code 12 was changed
8/1/2010 - The description for Bill Type Code 13 was changed 8/1/2010 - The description for Bill Type Code 14 was changed 8/1/2010 - The description for Bill Type Code 21 was changed 8/1/2010 - The description for Bill Type Code 72 was changed 8/1/2010 - The description for Bill Type Code 85 was changed
8/1/2010 - The description for Revenue code 0920 was changed 8/1/2010 - The description for Revenue code 0940 was changed
11/21/2010 - For the following CPT/HCPCS codes either the short description and/or the long description was changed. Depending on which description is used in this LCD, there may not be any change in how the code displays in the document:
93701 descriptor was changed in Group 1
08/27/2011 - This policy was updated by the ICD-9 2011-2012 Annual Update.
Reason for Change
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All Versions
Updated on 09/14/2011 with effective dates 10/01/2011 - N/A
Updated on 11/21/2010 with effective dates 01/01/2010 - 09/30/2011 Updated on 08/01/2010 with effective dates 01/01/2010 - N/A Updated on 08/01/2010 with effective dates 01/01/2010 - N/A Updated on 12/21/2009 with effective dates 01/01/2010 - N/A Updated on 11/15/2009 with effective dates 02/16/2009 - N/A Updated on 11/29/2008 with effective dates 02/16/2009 - N/A