SUPERCEDED LCD: Centers for Medicare & Medicaid Services

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Contractor Information

Contractor Name ^{back to top}

Palmetto GBA
Contractor Number ^{back to top}
00380
Contractor Type ^{back to top}
FI

LCD Information

LCD ID Number ^{back to top}

L26117

LCD Title ^{back to top}
Folic Acid, Serum

Contractor's Determination Number ^{back to top}


AMA CPT / ADA CDT Copyright Statement ^{back to top}
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.

CMS National Coverage Policy ^{back to top}
Title XVIII of the Social Security Act, §1862(a)(7) excludes routine physical examinations. 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. CMS Manual System, Pub 100-08, Medicare Program Integrity, Transmittal 63, dated January 23, 2004, Change Request 3010

Primary Geographic Jurisdiction ^{back to top}
South Carolina

Secondary Geographic Jurisdiction ^{back to top}


Oversight Region ^{back to top}
Region IV

Original Determination Effective Date ^{back to top}
For services performed on or after 01/07/2008

Original Determination Ending Date ^{back to top}


Revision Effective Date ^{back to top}
For services performed on or after 10/01/2008

Revision Ending Date ^{back to top}
09/02/2009

Indications and Limitations of Coverage and/or Medical Necessity ^{back to top}
Folic acid, also known as folate, is a B complex vitamin which serves as a carrier of one-carbon groups in many metabolic reactions. As tetrahydrofolate, it is required in the synthesis and catabolism of several amino acids, the formation of creatine and choline, the methylation of RNAs, the synthesis of purines, and the synthesis of DNA. Folic acid deficiency is usually nutritional in origin, and results in megaloblastic anemia. Serum folic acid levels are generally indicated in the evaluation of megaloblastic anemias whose cause is unknown, and in the setting of nutritional deficiency states, alcoholism, pregnancy, and malabsorption. Therapy with certain drugs, especially dihydrofolate reductase inhibitors such as methotrexate and trimethoprim, can result in folic acid deficiency and may be an indication to determine serum folic acid levels. Except in malabsorptive states where periodic serum folic acid determination may help in monitoring disease severity, sequential testing for folic acid is usually unnecessary, as response to treatment can be ascertained through increase in hemoglobin, hematocrit or decrease in macrocytosis/megaloblastosis.

Coding Information

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)

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.

030X

CPT/HCPCS Codes ^{back to top}

82746 FOLIC ACID; SERUM

ICD-9 Codes that Support Medical Necessity ^{back to top}

040.2	WHIPPLE'S DISEASE
261	NUTRITIONAL MARASMUS
262	OTHER SEVERE PROTEIN-CALORIE MALNUTRITION
263.0	MALNUTRITION OF MODERATE DEGREE
263.2 - 263.9	ARRESTED DEVELOPMENT FOLLOWING PROTEIN-CALORIE MALNUTRITION - UNSPECIFIED PROTEIN-CALORIE MALNUTRITION
266.2	OTHER B-COMPLEX DEFICIENCIES
267	ASCORBIC ACID DEFICIENCY
281.2	FOLATE-DEFICIENCY ANEMIA
281.3	OTHER SPECIFIED MEGALOBLASTIC ANEMIAS NOT ELSEWHERE CLASSIFIED
281.9	UNSPECIFIED DEFICIENCY ANEMIA
282.0 - 282.9	HEREDITARY SPHEROCYTOSIS - HEREDITARY HEMOLYTIC ANEMIA UNSPECIFIED
283.0 - 283.9	AUTOIMMUNE HEMOLYTIC ANEMIAS - ACQUIRED HEMOLYTIC ANEMIA UNSPECIFIED
285.9	ANEMIA UNSPECIFIED
303.90 - 303.92	OTHER AND UNSPECIFIED ALCOHOL DEPENDENCE UNSPECIFIED DRINKING BEHAVIOR - OTHER AND UNSPECIFIED ALCOHOL DEPENDENCE EPISODIC DRINKING BEHAVIOR
355.9	MONONEURITIS OF UNSPECIFIED SITE
356.9	UNSPECIFIED IDIOPATHIC PERIPHERAL NEUROPATHY
529.6	GLOSSODYNIA
555.0 - 555.9	REGIONAL ENTERITIS OF SMALL INTESTINE - REGIONAL ENTERITIS OF UNSPECIFIED SITE
579.0 - 579.9	CELIAC DISEASE - UNSPECIFIED INTESTINAL MALABSORPTION
648.90 - 648.94	OTHER CURRENT CONDITIONS CLASSIFIABLE ELSEWHERE OF MOTHER COMPLICATING PREGNANCY CHILDBIRTH OR THE PUERPERIUM UNSPECIFIED AS TO EPISODE OF CARE - OTHER CURRENT CONDITIONS CLASSIFIABLE ELSEWHERE OF MOTHER POSTPARTUM
782.0	DISTURBANCE OF SKIN SENSATION
V23.7	SUPERVISION OF HIGH-RISK PREGNANCY WITH INSUFFICIENT PRENATAL CARE
V45.11	RENAL DIALYSIS STATUS
V45.3	POSTSURGICAL INTESTINAL BYPASS OR ANASTOMOSIS STATUS

Diagnoses that Support Medical Necessity ^{back to top}

N/A

ICD-9 Codes that DO NOT Support Medical Necessity ^{back to top}

N/A

ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation ^{back to top}

Diagnoses that DO NOT Support Medical Necessity ^{back to top}

N/A

General Information

Documentation Requirements ^{back to top}

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.

Appendices ^{back to top}

N/A

Utilization Guidelines ^{back to top}

N/A

Sources of Information and Basis for Decision ^{back to top}

Local Coverage Determination, 97NC-001-L, Folic Acid, Serum, FI, North Carolina

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.

Start Date of Comment Period ^{back to top}

08/23/2007

End Date of Comment Period ^{back to top}

10/08/2007

Start Date of Notice Period ^{back to top}

11/21/2007

Revision History Number ^{back to top}

Revision #3, 10/01/2008
Revision #2, 08/14/2008
Revision #1, 01/07/2008

Revision History Explanation ^{back to top}

Revision #3, 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, V45.1 was carried out to a fifth digit and V45.11 was added. This policy becomes effective 10/01/2008.

Revision #2, 08/14/2008
This LCD has had its annual validation. No changes made. This revision becomes effective on 08/14/2008.

Revision #1, 01/07/2008
Under AMA/CPT & ADA/CDT Copyright Statement changed the copyright date from 2006 to 2007. No comments were received during the comment period. The notice period becomes effective 11/21/2007. This policy becomes effective 01/07/2008.

08/10/2008 - This policy was updated by the ICD-9 2008-2009 Annual Update.

Reason for Change ^{back to top}

HCPCS/ICD9 Descriptor Change
ICD9 Addition/Deletion

Last Reviewed On Date ^{back to top}

09/18/2008

Medicare Coverage Database

LCD for Folic Acid, Serum (L26117)