LCD/NCD Portal
Automated World Health
L29001 ULTRASOUND, SOFT TISSUES OF HEAD AND NECK
02/02/2009
Indications and Limitations of Coverage and/or Medical Necessity
Medicare will consider ultrasound of the head and neck medically reasonable and necessary when used for the following indications:
• Evaluation of abnormalities in the tissues and/or organs of the head and neck (i.e., palpable masses).
• Evaluation of abnormalities detected on other imaging examinations. (i.e., areas of abnormal uptake seen on radioisotope thyroid examinations).
• Personal or family history of thyroid malignancies.
• Evaluation of suspected regional nodal metastases in patients with a proven thyroid carcinoma
• Follow-up of lesion/nodule. (i.e., after medical suppression therapy).
• Localization of thyroid/parathyroid glands or cervical lymph nodes for biopsy, ablation, or other interventional procedures.
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.
12x Hospital Inpatient (Medicare Part B only)
13x Hospital Outpatient
14x Hospital - Laboratory Services Provided to Non-patients
21x Skilled Nursing - Inpatient (Including Medicare Part A)
22x Skilled Nursing - Inpatient (Medicare Part B only)
23x Skilled Nursing - Outpatient
75x Clinic - Comprehensive Outpatient Rehabilitation Facility (CORF)
85x 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.
0320 Radiology - Diagnostic - General Classification
0321 Radiology - Diagnostic - Angiocardiology
0322 Radiology - Diagnostic - Arthrography
0323 Radiology - Diagnostic - Arteriography
0324 Radiology - Diagnostic - Chest X-Ray
0329 Radiology - Diagnostic - Other Radiology - Diagnostic
CPT/HCPCS Codes
76536 ULTRASOUND, SOFT TISSUES OF HEAD AND NECK (EG, THYROID, PARATHYROID, PAROTID), REAL TIME WITH IMAGE DOCUMENTATION
ICD-9 Codes that Support Medical Necessity
171.0 MALIGNANT NEOPLASM OF CONNECTIVE AND OTHER SOFT TISSUE OF HEAD FACE AND NECK
193 MALIGNANT NEOPLASM OF THYROID GLAND
194.0 MALIGNANT NEOPLASM OF ADRENAL GLAND
194.1 MALIGNANT NEOPLASM OF PARATHYROID GLAND
194.5 MALIGNANT NEOPLASM OF CAROTID BODY
195.0 MALIGNANT NEOPLASM OF HEAD FACE AND NECK
196.0 SECONDARY AND UNSPECIFIED MALIGNANT NEOPLASM OF LYMPH NODES OF HEAD FACE AND NECK
200.01 RETICULOSARCOMA INVOLVING LYMPH NODES OF HEAD FACE AND NECK
200.11 LYMPHOSARCOMA INVOLVING LYMPH NODES OF HEAD FACE AND NECK
200.31 MARGINAL ZONE LYMPHOMA,LYMPH NODES OF HEAD, FACE, AND NECK
200.41 MANTLE CELL LYMPHOMA, LYMPH NODES OF HEAD, FACE, AND NECK
200.51 PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA, LYMPH NODES OF HEAD, FACE, AND NECK
200.61 ANAPLASTIC LARGE CELL LYMPHOMA, LYMPH NODES OF HEAD, FACE, AND NECK
200.71 LARGE CELL LYMPHOMA, LYMPH NODES OF HEAD, FACE, AND NECK
202.71 PERIPHERAL T CELL LYMPHOMA, LYMPH NODES OF HEAD, FACE, AND NECK
215.0 OTHER BENIGN NEOPLASM OF CONNECTIVE AND OTHER SOFT TISSUE OF HEAD FACE AND NECK
226 BENIGN NEOPLASM OF THYROID GLANDS
227.1 BENIGN NEOPLASM OF PARATHYROID GLAND
234.8 CARCINOMA IN SITU OF OTHER SPECIFIED SITES
239.7 NEOPLASM OF UNSPECIFIED NATURE OF ENDOCRINE GLANDS AND OTHER PARTS OF NERVOUS SYSTEM
240.0 GOITER SPECIFIED AS SIMPLE
240.9 GOITER UNSPECIFIED
241.0 NONTOXIC UNINODULAR GOITER
241.1 NONTOXIC MULTINODULAR GOITER
241.9 UNSPECIFIED NONTOXIC NODULAR GOITER
242.00 TOXIC DIFFUSE GOITER WITHOUT THYROTOXIC CRISIS OR STORM
242.01 TOXIC DIFFUSE GOITER WITH THYROTOXIC CRISIS OR STORM
242.10 TOXIC UNINODULAR GOITER WITHOUT THYROTOXIC CRISIS OR STORM
242.11 TOXIC UNINODULAR GOITER WITH THYROTOXIC CRISIS OR STORM
242.20 TOXIC MULTINODULAR GOITER WITHOUT THYROTOXIC CRISIS OR STORM
242.21 TOXIC MULTINODULAR GOITER WITH THYROTOXIC CRISIS OR STORM
242.30 TOXIC NODULAR GOITER UNSPECIFIED TYPE WITHOUT THYROTOXIC CRISIS OR STORM
242.31 TOXIC NODULAR GOITER UNSPECIFIED TYPE WITH THYROTOXIC CRISIS OR STORM
242.40 THYROTOXICOSIS FROM ECTOPIC THYROID NODULE WITHOUT THYROTOXIC CRISIS OR STORM
242.41 THYROTOXICOSIS FROM ECTOPIC THYROID NODULE WITH THYROTOXIC CRISIS OR STORM
242.80 THYROTOXICOSIS OF OTHER SPECIFIED ORIGIN WITHOUT THYROTOXIC CRISIS OR STORM
242.81 THYROTOXICOSIS OF OTHER SPECIFIED ORIGIN WITH THYROTOXIC CRISIS OR STORM
242.90 THYROTOXICOSIS WITHOUT GOITER OR OTHER CAUSE AND WITHOUT THYROTOXIC CRISIS OR STORM
242.91 THYROTOXICOSIS WITHOUT GOITER OR OTHER CAUSE WITH THYROTOXIC CRISIS OR STORM
245.0 ACUTE THYROIDITIS
245.1 SUBACUTE THYROIDITIS
245.9 THYROIDITIS UNSPECIFIED
246.0 DISORDERS OF THYROCALCITONIN SECRETION
246.1 DYSHORMONOGENIC GOITER
246.2 CYST OF THYROID
246.3 HEMORRHAGE AND INFARCTION OF THYROID
246.8 OTHER SPECIFIED DISORDERS OF THYROID
246.9 UNSPECIFIED DISORDER OF THYROID
252.8 OTHER SPECIFIED DISORDERS OF PARATHYROID GLAND
682.0 CELLULITIS AND ABSCESS OF FACE
682.1 CELLULITIS AND ABSCESS OF NECK
759.2 ANOMALIES OF OTHER ENDOCRINE GLANDS CONGENITAL
784.2 SWELLING MASS OR LUMP IN HEAD AND NECK
785.6 ENLARGEMENT OF LYMPH NODES
794.5 NONSPECIFIC ABNORMAL RESULTS OF FUNCTION STUDY OF THYROID
V10.87 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF THYROID
V15.3 PERSONAL HISTORY OF IRRADIATION PRESENTING HAZARDS TO HEALTH
Documentation Requirements
• Medical record documentation maintained by the ordering/referring physician must indicate the medical necessity for the ultrasound of the head and neck covered by the Medicare program.
o The procedure results/report must be included in the patient’s medical record.
• If the provider of the ultrasound of the head and neck is other than the ordering/referring physician, the provider of the service must maintain hard copy documentation of the procedure results/report along with copies of the ordering/referring physician’s order for the procedure.
Treatment Logic
Sources of Information and Basis for Decision
FCSO LCD 29300, Ultrasound, Soft Tissues of Head and Neck, 02/02/2009. The official local coverage determination (LCD) is the version on the Medicare coverage database at www.cms.gov/medicare-coverage-database/.
Mosby’s Diagnostic and Laboratory Test Reference - 2nd Edition. Source used to define the procedure.
Taber’s Cyclopedic Medical Dictionary. Source used to define diagnoses.
Marqusee, E., Benson, C., et al (2000). How useful is ultrasonography in the management of thyroid nodules. Annuals of Internal Medicine; 133: 696-700. Source used to define indications for thyroid ultrasound.
AMA CPT / ADA CDT Copyright Statement
CPT codes, descriptions and other data only are copyright 2012 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.