LCD/NCD Portal

L29300

 

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.

 

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.

 

CMS LCD ULTRASOUND, SOFT TISSUES OF HEAD AND NECK