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| LCD Information |
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| LCD ID Number back to top |
| L1210 |
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| LCD Title back to top |
| Diagnostic Pap Smear |
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| Contractor's Determination Number back to top |
| 90A-0034-L |
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| AMA CPT / ADA CDT Copyright Statement back to top |
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CPT codes, descriptions and other data only are copyright
2009 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.
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| CMS National Coverage Policy back to top |
Title XVIII of the Social Security Act, §1862 (a)(1)(A) allows coverage and payment for only those services that are considered to be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.
Title XVIII of the Social Security Act, §1862 (a)(7) excludes routine physical examinations.
CMS Manual System, Pub 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 3, §190.2 and Part 4, §230.11
CMS Manual System, Pub. 100-08, Medicare Program Integrity, Transmittal 63, dated January 23, 2004, Change Request 3010
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| Primary Geographic Jurisdiction back to top |
South Carolina
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| Oversight Region back to top |
Region IV
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| Original Determination Effective Date back to top |
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For services performed on or after
11/15/1997
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| Original Determination Ending Date back to top |
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| Revision Effective Date back to top |
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For services performed on or after
10/01/2008
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| Revision Ending Date back to top |
| 09/02/2009 |
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| Indications and Limitations of Coverage and/or Medical Necessity back to top |
Pap Smear (Papanicolaou) Smear/Test is a cytological examination of a vaginal smear for early detection of cancer (especially of the cervix and uterus) employing exfoliated cells and special staining techniques, which differentiates disease tissue.
The coverage criteria for Diagnostic Pap smear can be found in the CMS Manual System, Pub. 100-03, Medicare National Coverage Determinations (Internet-Only Manual). |
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| Coding Information |
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Bill Type Codes: back to top
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 or home health visits (Part B only) |
| 13x |
Hospital-outpatient (HHA-A also) (under OPPS 13X must be used for ASC claims submitted for OPPS payment -- eff. 7/00) |
| 14x |
Non-Patient Laboratory Specimens |
| 18x |
Hospital-swing beds |
| 21x |
SNF-inpatient, Part A |
| 22x |
SNF-inpatient or home health visits (Part B only) |
| 23x |
SNF-outpatient (HHA-A also) |
| 71x |
Clinic-rural health |
| 73x |
Clinic-independent provider based FQHC (eff 10/91) |
| 85x |
Special facility or ASC surgery-rural primary care hospital (eff 10/94) |
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Revenue Codes: back to top
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. |
| 0311 |
Laboratory pathological-cytology |
| 0923 |
Other diagnostic services-pap smear |
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| CPT/HCPCS Codes back to top |
| 88141 |
Cytopath, c/v, interpret |
| 88142 |
Cytopath, c/v, thin layer |
| 88143 |
Cytopath c/v thin layer redo |
| 88147 |
Cytopath, c/v, automated |
| 88148 |
Cytopath, c/v, auto rescreen |
| 88150 |
Cytopath, c/v, manual |
| 88152 |
Cytopath, c/v, auto redo |
| 88153 |
Cytopath, c/v, redo |
| 88154 |
Cytopath, c/v, select |
| 88155 |
Cytopath, c/v, index add-on |
| 88164 |
Cytopath tbs, c/v, manual |
| 88165 |
Cytopath tbs, c/v, redo |
| 88166 |
Cytopath tbs, c/v, auto redo |
| 88167 |
Cytopath tbs, c/v, select |
| 88174 |
Cytopath, c/v auto, in fluid |
| 88175 |
Cytopath c/v auto fluid redo |
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| ICD-9 Codes that Support Medical Necessity back to top |
| 054.10 |
GENITAL HERPES UNSPECIFIED |
| 054.11 |
HERPETIC VULVOVAGINITIS |
| 054.12 |
HERPETIC ULCERATION OF VULVA |
| 078.0 |
MOLLUSCUM CONTAGIOSUM |
| 078.10 |
VIRAL WARTS UNSPECIFIED |
| 078.11 |
CONDYLOMA ACUMINATUM |
| 078.19 |
OTHER SPECIFIED VIRAL WARTS |
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090.0 - 099.9
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EARLY CONGENITAL SYPHILIS SYMPTOMATIC - VENEREAL DISEASE UNSPECIFIED |
| 112.1 |
CANDIDIASIS OF VULVA AND VAGINA |
| 112.2 |
CANDIDIASIS OF OTHER UROGENITAL SITES |
| 171.6 |
MALIGNANT NEOPLASM OF CONNECTIVE AND OTHER SOFT TISSUE OF PELVIS |
| 179 |
MALIGNANT NEOPLASM OF UTERUS-PART UNS |
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180.0 - 180.9
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MALIGNANT NEOPLASM OF ENDOCERVIX - MALIGNANT NEOPLASM OF CERVIX UTERI UNSPECIFIED SITE |
| 181 |
MALIGNANT NEOPLASM OF PLACENTA |
|
182.0 - 182.8
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MALIGNANT NEOPLASM OF CORPUS UTERI EXCEPT ISTHMUS - MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF BODY OF UTERUS |
|
183.0 - 183.8
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MALIGNANT NEOPLASM OF OVARY - MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF UTERINE ADNEXA |
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184.0 - 184.9
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MALIGNANT NEOPLASM OF VAGINA - MALIGNANT NEOPLASM OF FEMALE GENITAL ORGAN SITE UNSPECIFIED |
| 195.3 |
MALIGNANT NEOPLASM OF PELVIS |
| 198.6 |
SECONDARY MALIGNANT NEOPLASM OF OVARY |
| 198.82 |
SECONDARY MALIGNANT NEOPLASM OF GENITAL ORGANS |
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218.0 - 218.9
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SUBMUCOUS LEIOMYOMA OF UTERUS - LEIOMYOMA OF UTERUS UNSPECIFIED |
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219.0 - 219.9
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BENIGN NEOPLASM OF CERVIX UTERI - BENIGN NEOPLASM OF UTERUS PART UNSPECIFIED |
| 220 |
BENIGN NEOPLASM OF OVARY |
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221.0 - 221.9
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BENIGN NEOPLASM OF FALLOPIAN TUBE AND UTERINE LIGAMENTS - BENIGN NEOPLASM OF FEMALE GENITAL ORGAN SITE UNSPECIFIED |
| 233.1 |
CARCINOMA IN SITU OF CERVIX UTERI |
| 233.2 |
CARCINOMA IN SITU OF OTHER AND UNSPECIFIED PARTS OF UTERUS |
| 233.30 |
CARCINOMA IN SITU, UNSPECIFIED FEMALE GENITAL ORGAN |
| 233.31 |
CARCINOMA IN SITU, VAGINA |
| 233.39 |
CARCINOMA IN SITU, OTHER FEMALE GENITAL ORGAN |
| 233.9 |
CARCINOMA IN SITU OF OTHER AND UNSPECIFIED URINARY ORGANS |
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236.0 - 236.3
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NEOPLASM OF UNCERTAIN BEHAVIOR OF UTERUS - NEOPLASM OF UNCERTAIN BEHAVIOR OF OTHER AND UNSPECIFIED FEMALE GENITAL ORGANS |
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256.0 - 256.9
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HYPERESTROGENISM - UNSPECIFIED OVARIAN DYSFUNCTION |
| 616.0 |
CERVICITIS AND ENDOCERVICITIS |
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616.10 - 616.11
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VAGINITIS AND VULVOVAGINITIS UNSPECIFIED - VAGINITIS AND VULVOVAGINITIS IN DISEASES CLASSIFIED ELSEWHERE |
| 616.2 |
CYST OF BARTHOLIN'S GLAND |
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616.50 - 616.51
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ULCERATION OF VULVA UNSPECIFIED - ULCERATION OF VULVA IN DISEASES CLASSIFIED ELSEWHERE |
| 616.81 |
MUCOSITIS (ULCERATIVE) OF CERVIX, VAGINA, AND VULVA |
| 616.89 |
OTHER INFLAMMATORY DISEASE OF CERVIX, VAGINA AND VULVA |
| 616.9 |
UNSPECIFIED INFLAMMATORY DISEASE OF CERVIX VAGINA AND VULVA |
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617.0 - 617.9
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ENDOMETRIOSIS OF UTERUS - ENDOMETRIOSIS SITE UNSPECIFIED |
| 620.0 |
FOLLICULAR CYST OF OVARY |
| 620.1 |
CORPUS LUTEUM CYST OR HEMATOMA |
| 620.2 |
OTHER AND UNSPECIFIED OVARIAN CYST |
| 620.8 |
OTHER NONINFLAMMATORY DISORDERS OF OVARY FALLOPIAN TUBE AND BROAD LIGAMENT |
| 621.0 |
POLYP OF CORPUS UTERI |
| 621.1 |
CHRONIC SUBINVOLUTION OF UTERUS |
| 621.2 |
HYPERTROPHY OF UTERUS |
| 621.8 |
OTHER SPECIFIED DISORDERS OF UTERUS NOT ELSEWHERE CLASSIFIED |
| 622.0 |
EROSION AND ECTROPION OF CERVIX |
| 622.10 |
DYSPLASIA OF CERVIX, UNSPECIFIED |
| 622.11 |
MILD DYSPLASIA OF CERVIX |
| 622.12 |
MODERATE DYSPLASIA OF CERVIX |
| 622.7 |
MUCOUS POLYP OF CERVIX |
| 622.8 |
OTHER SPECIFIED NONINFLAMMATORY DISORDERS OF CERVIX |
| 622.9 |
UNSPECIFIED NONINFLAMMATORY DISORDER OF CERVIX |
| 623.0 |
DYSPLASIA OF VAGINA |
| 623.5 |
LEUKORRHEA NOT SPECIFIED AS INFECTIVE |
| 623.7 |
POLYP OF VAGINA |
| 623.8 |
OTHER SPECIFIED NONINFLAMMATORY DISORDERS OF VAGINA |
| 623.9 |
UNSPECIFIED NONINFLAMMATORY DISORDER OF VAGINA |
| 624.6 |
POLYP OF LABIA AND VULVA |
| 624.8 |
OTHER SPECIFIED NONINFLAMMATORY DISORDERS OF VULVA AND PERINEUM |
| 625.70 |
VULVODYNIA, UNSPECIFIED |
| 625.71 |
VULVAR VESTIBULITIS |
| 625.79 |
OTHER VULVODYNIA |
| 626.2 |
EXCESSIVE OR FREQUENT MENSTRUATION |
| 626.6 |
METRORRHAGIA |
| 626.7 |
POSTCOITAL BLEEDING |
| 626.8 |
OTHER DISORDERS OF MENSTRUATION AND OTHER ABNORMAL BLEEDING FROM FEMALE GENITAL TRACT |
| 626.9 |
UNSPECIFIED DISORDERS OF MENSTRUATION AND OTHER ABNORMAL BLEEDING FROM FEMALE GENITAL TRACT |
| 627.1 |
POSTMENOPAUSAL BLEEDING |
| 627.2 |
SYMPTOMATIC MENOPAUSAL OR FEMALE CLIMACTERIC STATES |
| 627.3 |
POSTMENOPAUSAL ATROPHIC VAGINITIS |
| 627.8 |
OTHER SPECIFIED MENOPAUSAL AND POSTMENOPAUSAL DISORDERS |
| 627.9 |
UNSPECIFIED MENOPAUSAL AND POSTMENOPAUSAL DISORDER |
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628.0 - 628.9
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INFERTILITY FEMALE ASSOCIATED WITH ANOVULATION - INFERTILITY FEMALE OF UNSPECIFIED ORIGIN |
| 649.70 |
CERVICAL SHORTENING, UNSPECIFIED AS TO EPISODE OF CARE OR NOT APPLICABLE |
| 649.71 |
CERVICAL SHORTENING, DELIVERED, WITH OR WITHOUT MENTION OF ANTEPARTUM CONDITION |
| 649.73 |
CERVICAL SHORTENING, ANTEPARTUM CONDITION OR COMPLICATION |
|
654.10 - 654.14
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TUMORS OF BODY OF UTERUS UNSPECIFIED AS TO EPISODE OF CARE IN PREGNANCY - TUMORS OF BODY OF UTERUS POSTPARTUM CONDITION OR COMPLICATION |
| 795.00 |
ABNORMAL GLANDULAR PAPANICOLAOU SMEAR OF CERVIX |
| 795.01 |
PAPANICOLAOU SMEAR OF CERVIX WITH ATYPICAL SQUAMOUS CELLS OF UNDETERMINED SIGNIFICANCE (ASC-US) |
| 795.02 |
PAPANICOLAOU SMEAR OF CERVIX WITH ATYPICAL SQUAMOUS CELLS CANNOT EXCLUDE HIGH GRADE SQUAMOUS INTRAEPITHELIAL LESION (ASC-H) |
| 795.03 |
PAPANICOLAOU SMEAR OF CERVIX WITH LOW GRADE SQUAMOUS INTRAEPITHELIAL LESION (LGSIL) |
| 795.04 |
PAPANICOLAOU SMEAR OF CERVIX WITH HIGH GRADE SQUAMOUS INTRAEPITHELIAL LESION (HGSIL) |
| 795.05 |
CERVICAL HIGH RISK HUMAN PAPILLOMAVIRUS (HPV) DNA TEST POSITIVE |
| 795.06 |
PAPANICOLAOU SMEAR OF CERVIX WITH CYTOLOGIC EVIDENCE OF MALIGNANCY |
| 795.07 |
SATISFACTORY CERVICAL SMEAR BUT LACKING TRANSFORMATION ZONE |
| 795.08 |
UNSATISFACTORY CERVICAL CYTOLOGY SMEAR |
| 795.09 |
OTHER ABNORMAL PAPANICOLAOU SMEAR OF CERVIX AND CERVICAL HPV |
| 795.10 |
ABNORMAL GLANDULAR PAPANICOLAOU SMEAR OF VAGINA |
| 795.11 |
PAPANICOLAOU SMEAR OF VAGINA WITH ATYPICAL SQUAMOUS CELLS OF UNDETERMINED SIGNIFICANCE (ASC-US) |
| 795.12 |
PAPANICOLAOU SMEAR OF VAGINA WITH ATYPICAL SQUAMOUS CELLS CANNOT EXCLUDE HIGH GRADE SQUAMOUS INTRAEPITHELIAL LESION (ASC-H) |
| 795.13 |
PAPANICOLAOU SMEAR OF VAGINA WITH LOW GRADE SQUAMOUS INTRAEPITHELIAL LESION (LGSIL) |
| 795.14 |
PAPANICOLAOU SMEAR OF VAGINA WITH HIGH GRADE SQUAMOUS INTRAEPITHELIAL LESION (HGSIL) |
| 795.15 |
VAGINAL HIGH RISK HUMAN PAPILLOMAVIRUS (HPV) DNA TEST POSITIVE |
| 795.16 |
PAPANICOLAOU SMEAR OF VAGINA WITH CYTOLOGIC EVIDENCE OF MALIGNANCY |
| 795.18 |
UNSATISFACTORY VAGINAL CYTOLOGY SMEAR |
| 795.19 |
OTHER ABNORMAL PAPANICOLAOU SMEAR OF VAGINA AND VAGINAL HPV |
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| Diagnoses that Support Medical Necessity back to top |
| N/A |
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| ICD-9 Codes that DO NOT Support Medical Necessity back to top |
N/A
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| ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation back to top |
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| Diagnoses that DO NOT Support Medical Necessity back to top |
| N/A |
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| General Information |
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| Documentation Requirements back to top |
1. Documentation supporting the medical necessity should be legible, maintained in the patient’s medical record, and must be made available to the Intermediary upon request.
2. The physician must order diagnostic Pap Smears and the documentation must support the medical necessity for the test being done.
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| Appendices back to top |
| N/A |
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| Utilization Guidelines back to top |
| This policy does not address Pap smears covered under the screening benefit described in §4102 of the Balanced Budget Amendment of 1997 (BBA) |
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| Sources of Information and Basis for Decision back to top |
Carr B, Bradshaw K. Disorders of the Ovary and Female Reproductive Tract. In: Fauci AS, Braunwald E, Kasper D, et al. eds. Harrison’s Principles of Internal Medicine. 16th ed. New York, NY: McGraw-Hill; 2005:2207-2208.
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| Advisory Committee Meeting Notes back to top |
| This policy does not reflect the sole opinion of the contractor or Contractor Medical Director. Although the final decision rests with the Intermediary, this policy was developed in cooperation with advisory groups, which include representatives from the affected provider community. Advisory Committee Meeting Date: N/A. |
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| Start Date of Comment Period back to top |
| 06/28/1997 |
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| End Date of Comment Period back to top |
| 08/11/1997 |
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| Start Date of Notice Period back to top |
| 10/15/1997 |
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| Revision History Number back to top |
Revision #15, 10/01/2008
Revision #14, 10/01/2007
Revision #13, 10/01/2006
Revision #12, 01/01/2006
Revision #11, 08/19/2005
Revision #10, 08/19/2005
Revision #9, 11/22/2004
Revision #8, 10/01/2004
Revision #7, 11/28/2003
Revision #6, 10/01/2003
Revision #5, 08/23/2002
Revision #4, 08/10/2001
Revision #3, 05/23/1999
Revision #2, 02/24/1999
Revision #1 |
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| Revision History Explanation back to top |
Revision #15, 10/01/2008
Under AMA/CPT & ADA/CDT Copyright Statement changed the copyright date from 2007 to 2008. Under ICD-9 Codes That Support Medical Necessity added ICD-9 codes 625.70, 625.71, 625.79, 649.70, 649.71, 649.73,795.07, and 795.08. ICD-9 code 795.1 was extended to a 5th digit to now read 795.10, 795.11, 795.12, 795.13, 795.14, 795.15, 795.16, 795.18, and 795.19.This revision becomes effective 10/01/2008.
Revision #14, 10/01/2007
Under AMA/ CPT & ADA/CDT Copyright Statement changed the copyright date from 2006 to 2007. Under CMS National Coverage Policy changed the publication number for the referenced manual from “100-3” to now read “100-03”. Under Indications and Limitations of Coverage and/or Medical Necessity changed the publication number for the referenced manual from “100-3” to now read “100-03”. Under ICD-9 Codes That Support Medical Necessity ICD-9 code 233.3 was extended to a 5th digit to now read 233.30, 233.31 and 233.39. During the ICD-9 code annual update review of this Local Coverage Determination (LCD) it was noted that ICD-9 code 233.0 was inadvertently added to the LCD. This ICD-9 code will be deleted. Under Sources of Information and Basis for Decision deleted the cited national policy and added the following reference: Carr B, Bradshaw K. Disorders of the Ovary and Female Reproductive Tract. In: Fauci AS, Braunwald E, Kasper D, et al. eds. Harrison’s Principles of Internal Medicine. 16th ed. New York, NY: McGraw-Hill; 2005:2207-2208. This policy was reviewed for annual validation. This revision becomes effective 10/01/2007.
Revision #13, 10/01/2006
Under AMA/ CPT & ADA/CDT Copyright Statement changed the copyright date from 2005 to 2006. Under CMS National Coverage Policy added Title XVIII of the Social Security Act, §1862 (a)(7)and changed Transmittal “62” to now read “63” for Change Request 3010. Under ICD-9 Codes That Support Medical Necessity ICD-9 code 616.8 extended to now read 616.81 and 616.89 and added ICD-9 code 795.06. Under Advisory Committee Meeting Notes changed “affected providers” to “the affected provider community.” This policy was reviewed for annual validation. This revision becomes effective 10/01/2006.
Revision #12, 01/01/2006
Under CMS National Coverage Policy deleted Change Request 2592. Under CPT/HCPCS Codes changed the verbiage to short descriptors.Under Does the "CPT 30% Coding Rule" Apply the verbiage was changed to "Yes". This revision becomes effective January 1, 2006.
Revision #11, 08/19/2005
This revision is to correct a typographical error in Revision #10. Federally Qualified Health Centers should be abbreviated FQHC not HQHC. This revision will become effective on 08/19/2005.
Revision #10, 08/19/2005
This policy was converted to a Local Coverage Determination as directed per change request 3010.
Under CMS National Coverage Policy section of this policy the following citations have been deleted as they relate to screening Pap smears not diagnostic Pap smears:
Balanced Budget Act (BBA) of 1997, section 4102 (screening Pap smear and pelvic exam)
Benefits Improvement and Protection Act of 2000, Title 1, Section 101.
Program Memorandum, Transmittal AB-02-163, dated November 8, 2002, Change Request 2420
These citations were added:
Title XVIII of the Social Security Act, section 1862 (a)(1)(A) allows coverage and payment for only those services that are considered to be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.
CMS Manual System, Pub. 100-08, Medicare Program Integrity, Transmittal 62, dated January 23, 2004, Change Request 3010
Under Indications and Limitations of Coverage and/or Medical Necessity section the language found in the National Coverage Decision (NCD) was removed. Under the section Types of Bill Codes Federally Qualified Health Centers (HQHCs) was added. Under the Revenue Codes section 0923 for Pap smears was added. Under Utilization Guidelines section the reference to the BBA regarding screening Pap smears is listed. The Sources of Information and Basis for Decision section also contained the reference to the BBA; therefore it was deleted from here. This revision becomes effective 08/19/2005.
Revision #9, 11/22/2004
Under AMA CPT Copyright Statement section of this policy, deleted reference to CDT-4 copyright language as this policy does not contain CDT-4 codes or descriptions. Under ICD-9 Codes That Do Not Support Medical Necessity section of this policy deleted the verbiage related to Appeal rights, as this information will appear on the Palmetto GBA web site under Appeals information. These changes become effective 11/22/2004.
Under CPT/HCPCS Codes there were a verbiage change to CPT code 88141. This change becomes effective 01/01/2005.
Revision #8, 10/01/2004
Under AMA CPT Copyright Statement changed the copyright date from 2003 to 2004. Added the American Dental Association copyright statement. Under CMS National Coverage Policy section of this policy deleted Change Requests 1661 and 1021. Added Program Memorandum Transmittal AB-02-163 dated November 8, 2002, Change Request 2420, Benefits Improvement and Protection Act of 2000, Title 1, Section 101 and CMS Manual System, Pub 100-3, Medicare National Coverage Determinations Manual, Chapter 1, Part 3, Section 190.2 and Part 4, Section 230.11 Under Benefit Category changed the verbiage from Screening Pap Smear to Diagnostic Laboratory Tests. Under CPT/HCPCS Codes added CPT codes 88174 and 88175 per Change Request 2420. Under ICD-9 Codes That Support Medical Necessity extended ICD-9 code 622.1 to 622.10. Added ICD-9 codes 622.11, 622.12, 795.03, 795.04, 795.05, and 795.08. Verbiage changed for ICD-9 codes 795.00, 795.01, 795.02, and 795.09. Under Other Comments added statement #4 to indicate screening frequency for pelvic exams from once every 3 years to once every 2 years. Added NCD citation for statement #5 and changed Local Medical Review Policy to Local Coverage Determination. These changes become effective 10/01/2004.
Revision #7, 11/28/2003
Under CMS National Coverage Policy section of this policy the manual citation has been changed to reflect the Internet Only Manual (IOM). This change becomes effective 11/28/2003.
Revision #6, 10/01/2003
The copyright date was changed to 2003 under the section AMA CPT Copyright Statement. CMS Pub. 100-8, Medicare Program Integrity, Transmittal 44, dated July 25, 2003, Change Request 2592 was added under the section CMS National Coverage Policy. These changes will become effective 10/01/2003.
Revision #5, 08/23/2002
ICD-9-CM code 795.0 has been changed to include the 5th digit 795.00. ICD –9-Cm codes, 795.01, 795.02, and 795.09 have been added to the list of ICD-9-CM Codes That Support Medical Necessity section of this policy. Under Type of Bill Code section, Critical Access Hospital (85x) has been added to the policy. Deleted CPT codes, 88144 and 88145 under CPT/HCPCS CODES section of this policy. These changes become effective 10/01/2002.
Revision #4 08/10/2001
Policy format has been revised to be consistent with changes set forth in Program Integrity Manual Transmittal #9, Change Request 1021, Dated July 30, 2001. ICD-9-CM codes have been reviewed and updated as per Program Memorandum Transmittal AB-01-91, Change Request 1661, Dated June 28, 2001.
Revision #3 05/23/1999
Cited in the policy
Revision #2 02/24/1999
Reflects changes to CPT and ICD-9-CM codes and coding guidelines.
Revision #1
This LCD was converted from an LMRP on 7/19/2005
11/09/2008 - The description for CPT/HCPCS code 88155 was changed in group 1 |
| |
| Reason for Change back to top |
HCPCS/ICD9 Descriptor Change
ICD9 Addition/Deletion
|
| Last Reviewed On Date back to top |
| 09/18/2008 |
| |
| Related Documents back to top |
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This LCD has no Related Documents.
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| LCD Attachments back to top |
| There are no attachments for this LCD. |
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