CMS Moves Billing Codes out of LCDs and into Billing and Coding Articles

In response to a provision of the 21st Century Cures Act, the Centers for Medicare & Medicaid Services (CMS) revised chapter 13 of the Medicare Program Integrity Manual (PIM). This chapter describes the local coverage determinations (LCD) process. One significant change is the relocation of billing codes (ICD-10-CM, CPT/HCPCS, Bill Type, and Revenue) from LCDs and into local coverage Articles. The MACs were expected to complete the work by January of 2020.

The Medicare Administrative Contractor (MAC) created a Billing and Coding Article that contains the codes removed from the LCD. The LCD and the Billing and Coding Article are companion documents. They are related to each other, and Medicare Coverage Database (MCD) users can see the relationship and access the related document by navigating to the “Related Local Coverage Documents” section in either the LCD or the Article.

More information on the changes made to PIM Chapter 13 and the LCD process can be found here: https://www.cms.gov/newsroom/fact-sheets/summary-significant-changes-medicare-program-integrity-manual-chapter-13-local-coverage.

LCDs and their associated articles are located in the MCD found here: https://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx.

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