SUPERCEDED LCD: Centers for Medicare & Medicaid Services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}

L867

LCD Title ^{back to top}
Rheumatoid Factor

Contractor's Determination Number ^{back to top}
98A-0015-L

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)(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 100-08, 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 09/21/1998

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}
09/30/2009

Indications and Limitations of Coverage and/or Medical Necessity ^{back to top}
Rheumatoid factor (RF) is an examination of the blood to determine the presence of rheumatoid factors (IgG or IgM molecules that react with altered IgG). This test is useful in confirming the diagnosis of rheumatoid arthritis when clinical examination is not conclusive. Rheumatoid factor testing is medically indicated for those patients whose clinical diagnosis is highly suspicious for rheumatoid arthritis and the blood test is needed for diagnostic confirmation. The patient’s treatment course would be dependent upon the outcome of the test. The Rheumatoid Factor (RF) blood test would be medically indicated after the clinical examination proves unable to distinguish between Rheumatoid Arthritis and the following conditions: a. Chronic Interstitial Fibrosis b. Chronic Hepatitis disease c. Infectious Mononucleosis d. Leprosy e. Polymyositis f. Sarcoidosis g. Scleroderma h. Subacute Bacterial Endocarditis i. Syphilis j. Systemic Lupus Erythematosus k. Tuberculosis It should be noted that elderly patients often have false-positive results.

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.

0300 - 0309 Laboratory-general classification - Laboratory-other laboratory

CPT/HCPCS Codes ^{back to top}

86430	RHEUMATOID FACTOR; QUALITATIVE
86431	RHEUMATOID FACTOR; QUANTITATIVE

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

010.00 - 010.86	PRIMARY TUBERCULOUS COMPLEX UNSPECIFIED EXAMINATION - OTHER PRIMARY PROGRESSIVE TUBERCULOSIS TUBERCLE BACILLI NOT FOUND BY BACTERIOLOGICAL OR HISTOLOGICAL EXAMINATION BUT TUBERCULOSIS CONFIRMED BY OTHER METHODS (INOCULATION OF ANIMALS)
015.00 - 015.26	TUBERCULOSIS OF VERTEBRAL COLUMN UNSPECIFIED EXAMINATION - TUBERCULOSIS OF KNEE TUBERCLE BACILLI NOT FOUND BY BACTERIOLOGICAL OR HISTOLOGICAL EXAMINATION BUT TUBERCULOSIS CONFIRMED BY OTHER METHODS (INOCULATION OF ANIMALS)
015.50 - 015.76	TUBERCULOSIS OF LIMB BONES UNSPECIFIED EXAMINATION - TUBERCULOSIS OF OTHER SPECIFIED BONE TUBERCLE BACILLI NOT FOUND BY BACTERIOLOGICAL OR HISTOLOGICAL EXAMINATION BUT TUBERCULOSIS CONFIRMED BY OTHER METHODS (INOCULATION OF ANIMALS)
015.80 - 015.96	TUBERCULOSIS OF OTHER SPECIFIED JOINT UNSPECIFIED EXAMINATION - TUBERCULOSIS OF UNSPECIFIED BONES AND JOINTS TUBERCLE BACILLI NOT FOUND BY BACTERIOLOGICAL OR HISTOLOGICAL EXAMINATION BUT TUBERCULOSIS CONFIRMED BY OTHER METHODS (INOCULATION OF ANIMALS)
030.0 - 030.8	LEPROMATOUS LEPROSY (TYPE L) - OTHER SPECIFIED LEPROSY
030.9	LEPROSY UNSPECIFIED
075	INFECTIOUS MONONUCLEOSIS
091.0 - 091.9	GENITAL SYPHILIS (PRIMARY) - UNSPECIFIED SECONDARY SYPHILIS
095.8	OTHER SPECIFIED FORMS OF LATE SYMPTOMATIC SYPHILIS
135	SARCOIDOSIS
204.00	ACUTE LYMPHOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION
204.01	LYMPHOID LEUKEMIA ACUTE IN REMISSION
204.02	ACUTE LYMPHOID LEUKEMIA, IN RELAPSE
204.10	CHRONIC LYMPHOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION
204.11	LYMPHOID LEUKEMIA CHRONIC IN REMISSION
204.12	CHRONIC LYMPHOID LEUKEMIA, IN RELAPSE
204.20	SUBACUTE LYMPHOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION
204.21	LYMPHOID LEUKEMIA SUBACUTE IN REMISSION
204.22	SUBACUTE LYMPHOID LEUKEMIA, IN RELAPSE
204.80	OTHER LYMPHOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION
204.81	OTHER LYMPHOID LEUKEMIA IN REMISSION
204.82	OTHER LYMPHOID LEUKEMIA, IN RELAPSE
204.90	UNSPECIFIED LYMPHOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION
204.91	UNSPECIFIED LYMPHOID LEUKEMIA IN REMISSION
204.92	UNSPECIFIED LYMPHOID LEUKEMIA, IN RELAPSE
205.00	ACUTE MYELOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION
205.01	MYELOID LEUKEMIA ACUTE IN REMISSION
205.02	ACUTE MYELOID LEUKEMIA, IN RELAPSE
205.10	CHRONIC MYELOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION
205.11	MYELOID LEUKEMIA CHRONIC IN REMISSION
205.12	CHRONIC MYELOID LEUKEMIA, IN RELAPSE
205.20	SUBACUTE MYELOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION
205.21	MYELOID LEUKEMIA SUBACUTE IN REMISSION
205.22	SUBACUTE MYELOID LEUKEMIA, IN RELAPSE
205.30	MYELOID SARCOMA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION
205.31	MYELOID SARCOMA IN REMISSION
205.32	MYELOID SARCOMA, IN RELAPSE
205.80	OTHER MYELOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION
205.81	OTHER MYELOID LEUKEMIA IN REMISSION
205.82	OTHER MYELOID LEUKEMIA, IN RELAPSE
205.90	UNSPECIFIED MYELOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION
205.91	UNSPECIFIED MYELOID LEUKEMIA IN REMISSION
205.92	UNSPECIFIED MYELOID LEUKEMIA, IN RELAPSE
206.00	ACUTE MONOCYTIC LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION
206.01	MONOCYTIC LEUKEMIA ACUTE IN REMISSION
206.02	ACUTE MONOCYTIC LEUKEMIA, IN RELAPSE
206.10	CHRONIC MONOCYTIC LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION
206.11	MONOCYTIC LEUKEMIA CHRONIC IN REMISSION
206.12	CHRONIC MONOCYTIC LEUKEMIA, IN RELAPSE
206.20	SUBACUTE MONOCYTIC LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION
206.21	MONOCYTIC LEUKEMIA SUBACUTE IN REMISSION
206.22	SUBACUTE MONOCYTIC LEUKEMIA, IN RELAPSE
206.80	OTHER MONOCYTIC LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION
206.81	OTHER MONOCYTIC LEUKEMIA IN REMISSION
206.82	OTHER MONOCYTIC LEUKEMIA, IN RELAPSE
206.90	UNSPECIFIED MONOCYTIC LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION
206.91	UNSPECIFIED MONOCYTIC LEUKEMIA IN REMISSION
206.92	UNSPECIFIED MONOCYTIC LEUKEMIA, IN RELAPSE
207.00	ACUTE ERYTHREMIA AND ERYTHROLEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION
207.01	ACUTE ERYTHREMIA AND ERYTHROLEUKEMIA IN REMISSION
207.02	ACUTE ERYTHREMIA AND ERYTHROLEUKEMIA, IN RELAPSE
207.10	CHRONIC ERYTHREMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION
207.11	CHRONIC ERYTHREMIA IN REMISSION
207.12	CHRONIC ERYTHREMIA, IN RELAPSE
207.20	MEGAKARYOCYTIC LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION
207.21	MEGAKARYOCYTIC LEUKEMIA IN REMISSION
207.22	MEGAKARYOCYTIC LEUKEMIA, IN RELAPSE
207.80	OTHER SPECIFIED LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION
207.81	OTHER SPECIFIED LEUKEMIA IN REMISSION
207.82	OTHER SPECIFIED LEUKEMIA, IN RELAPSE
208.00	ACUTE LEUKEMIA OF UNSPECIFIED CELL TYPE, WITHOUT MENTION OF HAVING ACHIEVED REMISSION
208.01	LEUKEMIA OF UNSPECIFIED CELL TYPE ACUTE IN REMISSION
208.02	ACUTE LEUKEMIA OF UNSPECIFIED CELL TYPE, IN RELAPSE
208.10	CHRONIC LEUKEMIA OF UNSPECIFIED CELL TYPE, WITHOUT MENTION OF HAVING ACHIEVED REMISSION
208.11	LEUKEMIA OF UNSPECIFIED CELL TYPE CHRONIC IN REMISSION
208.12	CHRONIC LEUKEMIA OF UNSPECIFIED CELL TYPE, IN RELAPSE
208.20	SUBACUTE LEUKEMIA OF UNSPECIFIED CELL TYPE, WITHOUT MENTION OF HAVING ACHIEVED REMISSION
208.21	LEUKEMIA OF UNSPECIFIED CELL TYPE SUBACUTE IN REMISSION
208.22	SUBACUTE LEUKEMIA OF UNSPECIFIED CELL TYPE, IN RELAPSE
208.80	OTHER LEUKEMIA OF UNSPECIFIED CELL TYPE, WITHOUT MENTION OF HAVING ACHIEVED REMISSION
208.81	OTHER LEUKEMIA OF UNSPECIFIED CELL TYPE IN REMISSION
208.82	OTHER LEUKEMIA OF UNSPECIFIED CELL TYPE, IN RELAPSE
208.90	UNSPECIFIED LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION
208.91	UNSPECIFIED LEUKEMIA IN REMISSION
208.92	UNSPECIFIED LEUKEMIA, IN RELAPSE
273.2	OTHER PARAPROTEINEMIAS
274.0	GOUTY ARTHROPATHY
277.39	OTHER AMYLOIDOSIS
285.9	ANEMIA UNSPECIFIED
403.11	HYPERTENSIVE CHRONIC KIDNEY DISEASE, BENIGN, WITH CHRONIC KIDNEY DISEASE STAGE V OR END STAGE RENAL DISEASE
421.0	ACUTE AND SUBACUTE BACTERIAL ENDOCARDITIS
421.9	ACUTE ENDOCARDITIS UNSPECIFIED
446.5	GIANT CELL ARTERITIS
516.3	IDIOPATHIC FIBROSING ALVEOLITIS
571.42	AUTOIMMUNE HEPATITIS
571.5	CIRRHOSIS OF LIVER WITHOUT ALCOHOL
571.6	BILIARY CIRRHOSIS
571.9	UNSPECIFIED CHRONIC LIVER DISEASE WITHOUT ALCOHOL
580.0 - 580.9	ACUTE GLOMERULONEPHRITIS WITH LESION OF PROLIFERATIVE GLOMERULONEPHRITIS - ACUTE GLOMERULONEPHRITIS WITH UNSPECIFIED PATHOLOGICAL LESION IN KIDNEY
581.1 - 581.9	NEPHROTIC SYNDROME WITH LESION OF MEMBRANOUS GLOMERULONEPHRITIS - NEPHROTIC SYNDROME WITH UNSPECIFIED PATHOLOGICAL LESION IN KIDNEY
582.0 - 582.9	CHRONIC GLOMERULONEPHRITIS WITH LESION OF PROLIFERATIVE GLOMERULONEPHRITIS - CHRONIC GLOMERULONEPHRITIS WITH UNSPECIFIED PATHOLOGICAL LESION IN KIDNEY
583.0 - 583.9	NEPHRITIS AND NEPHROPATHY NOT SPECIFIED AS ACUTE OR CHRONIC WITH LESION OF PROLIFERATIVE GLOMERULONEPHRITIS - NEPHRITIS AND NEPHROPATHY NOT SPECIFIED AS ACUTE OR CHRONIC WITH UNSPECIFIED PATHOLOGICAL LESION IN KIDNEY
584.5 - 584.9	ACUTE RENAL FAILURE WITH LESION OF TUBULAR NECROSIS - ACUTE RENAL FAILURE UNSPECIFIED
585.1 - 585.9	CHRONIC KIDNEY DISEASE, STAGE I - CHRONIC KIDNEY DISEASE, UNSPECIFIED
587	RENAL SCLEROSIS UNSPECIFIED
588.0	RENAL OSTEODYSTROPHY
701.0	CIRCUMSCRIBED SCLERODERMA
710.0 - 710.4	SYSTEMIC LUPUS ERYTHEMATOSUS - POLYMYOSITIS
710.9	UNSPECIFIED DIFFUSE CONNECTIVE TISSUE DISEASE
711.00 - 711.09	PYOGENIC ARTHRITIS SITE UNSPECIFIED - PYOGENIC ARTHRITIS INVOLVING MULTIPLE SITES
711.10 - 711.39	ARTHROPATHY SITE UNSPECIFIED ASSOCIATED WITH REITER'S DISEASE AND NONSPECIFIC URETHRITIS - POSTDYSENTERIC ARTHROPATHY INVOLVING MULTIPLE SITES
712.10 - 712.29	CHONDROCALCINOSIS DUE TO DICALCIUM PHOSPHATE CRYSTALS INVOLVING UNSPECIFIED SITE - CHONDROCALCINOSIS DUE TO PYROPHOSPHATE CRYSTALS INVOLVING MULTIPLE SITES
712.30 - 712.39	CHONDROCALCINOSIS CAUSE UNSPECIFIED INVOLVING UNSPECIFIED SITE - CHONDROCALCINOSIS CAUSE UNSPECIFIED INVOLVING MULTIPLE SITES
712.80 - 712.99	OTHER SPECIFIED CRYSTAL ARTHROPATHIES SITE UNSPECIFIED - UNSPECIFIED CRYSTAL ARTHROPATHY INVOLVING MULTIPLE SITES
713.0 - 713.6	ARTHROPATHY ASSOCIATED WITH OTHER ENDOCRINE AND METABOLIC DISORDERS - ARTHROPATHY ASSOCIATED WITH HYPERSENSITIVITY REACTION
714.0 - 714.2	RHEUMATOID ARTHRITIS - OTHER RHEUMATOID ARTHRITIS WITH VISCERAL OR SYSTEMIC INVOLVEMENT
714.30 - 714.33	CHRONIC OR UNSPECIFIED POLYARTICULAR JUVENILE RHEUMATOID ARTHRITIS - MONOARTICULAR JUVENILE RHEUMATOID ARTHRITIS
714.4	CHRONIC POSTRHEUMATIC ARTHROPATHY
714.81	RHEUMATOID LUNG
714.89	OTHER SPECIFIED INFLAMMATORY POLYARTHROPATHIES
714.9	UNSPECIFIED INFLAMMATORY POLYARTHROPATHY
719.00 - 719.09	EFFUSION OF JOINT SITE UNSPECIFIED - EFFUSION OF JOINT OF MULTIPLE SITES
719.40 - 719.49	PAIN IN JOINT SITE UNSPECIFIED - PAIN IN JOINT INVOLVING MULTIPLE SITES
725	POLYMYALGIA RHEUMATICA

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}

Jacobs D, et al. Laboratory Test Handbook. 4th edition. 1996: 427.

CMD Clinical Laboratory Workgroup

Mosby’s Diagnostic and Laboratory Test Reference. 2nd Edition. 1995.

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}

06/02/1998

End Date of Comment Period ^{back to top}

07/17/1998

Start Date of Notice Period ^{back to top}

08/21/1998

Revision History Number ^{back to top}

Revision #12, 10/01/2008
Revision #11, 08/22/2007
Revision #10,10/01/2006
Revision #9, 03/01/2006
Revision #8, 10/01/2005
Revision #7, 04/06/2005
Revision #6, 11/22/2004
Revision #5, 10/01/2004
Revision #4, 10/01/2003
Revision #3, 09/11/2002
Revision #2, 10/15/2000
Revision #1, 10/15/1999

Revision History Explanation ^{back to top}

Revision #12, 10/01/2008
Under AMA/CPT & ADA/CDT Copyright Statement the copyright date was changed from 2007 to 2008. Under ICD-9 Codes That Support Medical Necessity added ICD-9 codes 204.02, 204.12, 204.22, 204.82, 204.92, 205.02, 205.12, 205.22, 205.32, 205.82, 205.92, 206.02, 206.12, 206.22, 206.82, 206.92, 207.02, 207.12, 207.22, 207.82, 208.02, 208.12, 208.22, 208.82, 208.92 and 571.42. This policy becomes effective 10/01/2008.

Revision #11, 08/22/2007
Under AMA/CPT & ADA/CDT Copyright Statement the copyright date was changed from 2006 to 2007. Under CMS National Coverage Policy changed the publication number for the referenced CMS Manual System, “100-8” to now read “100-08”. Under ICD-9 Codes That Do Not Support Medical Necessity changed the verbiage to now read N/A. This policy was reviewed for annual validation. This revision becomes effective 08/22/2007.

Revision #10, 10/01/2006
Under AMA/CPT & ADA/CDT Copyright Statement the copyright date was changed from 2005 to 2006. Under ICD-9 Codes That Support Medical Necessity added ICD-9 code 277.39. The verbiage for ICD-9 code 403.11 was revised. Under Sources of Information and Basis for Decision deleted the reference to the Tennessee and Florida Carrier and Fiscal Intermediary LCD’s. All other references were placed in the AMA citation format. This policy was reviewed for annual validation. This policy becomes effective 10/01/2006.

Revision #9, 03/01/2006
Under CMS National Coverage Policy section of the policy the verbiage was changed for Title XVIII of the Social Security Act, Section 1862 (a)(7). Under Advisory Committee Meeting Notes changed the word “affective” to now read “affected”. This revision becomes effective 03/01/2006.

Revision #8, 10/01/2005
Under CMS National Coverage Policy section of the policy the verbiage was changed under Title XVIII of the Social Security Act, section 1862 (a)(1)(A) to read, “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. Under ICD-9 Codes That Support Medical Necessity section of policy ICD-9 code 585 that was originally added to the policy on 04/06/05 expanded to 585.1-585.9. These changes become effective on 10/01/2005.

Revision #7, 04/06/2005
Converted the LMRP to a LCD. This change becomes effective 03/23/2005.
Under LCD Title, title changed to read Rheumatoid Factor. Under CMS National Coverage Policy verbiage changed for Title XVIII of the Social Security Act, 1862 (a)(1)(A), deleted Change Request 2592 and added Change Request 3010. Under Indications and Limitations of Coverage added verbiage to read, “Rheumatoid factor is an… and “This test is…” Deleted statements #1, and #4. Added, “It should be noted…”Under Coverage Topic deleted diagnostic tests and x-ray’s. Under Revenue Codes, extended revenue codes to 309. Under ICD-9 Codes That Support Medical Necessity added 010.00-010.86,015.50-015.76, 030.0-030.8, 091.0-091.9, 204.00-204.91, 205.00-205.91, 206.00-206.91, 207.00-207.81, 208.00-208.91, 403.11, 421.0, 571.5, 571.6, 580.0-580.9, 581.1-581.9, 582.0-582.9, 583.0-583.9, 584.5-584.9, 585, 587, 588.0, 711.00-711.09, 712.10-712.29, 719.00-719.09, and 719.40-719.49. Under ICD-9 Codes That Do Not Support Medical Necessity added verbiage. Under Documentation Requirements deleted statements #1-4. Under Sources of Information reconciled sources with the NC policy. These changes become effective 04/06/2005.

Revision #6, 11/22/2004
Under Contractor Type added “Fiscal”. Under the AMA CPT Copyright Statement section of this policy, deleted the reference to CDT-4 copyright language, as this policy does not contain CDT-4 codes or descriptions. Under CPT/HCPCS Section deleted the reference to the Social Security Act. Under ICD-9 Codes That Support Medical Necessity 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.

Revision #5, 10/01/2004
Under the AMA CPT Copyright Statement section of this policy the copyright date was updated from 2003 to 2004. Per CMS the Dental Copyright statement was added. Under Type of Bill Code section of this policy Federally Qualified Health Centers (73x) was added. Under Sources of Information and Basis for Decision section the CPT Physicians’ Current Procedural Terminology, American Medical Association was deleted. These changes become effective 10/01/2004.

Revision #4, 10/01/2003
The copyright date was changed under 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 #3 09/11/2002
Under the Type of Bill Code section of this policy, Critical Access Hospital (85x) has been added. This change becomes effective 10/01/02.

Revision #2 10/15/2000

Revision #1 10/15/1999

This LCD was converted from an LMRP on 3/22/2005

09/04/2005 - This policy was updated by the ICD-9 2005-2006 Annual Update.

7/2/2006 - The description for Bill code 14 was changed

09/04/2006 - This policy was updated by the ICD-9 2006-2007 Annual Update.

2/18/2008 - The description for Bill code 21 was changed

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

Reason for Change ^{back to top}

ICD9 Addition/Deletion

Last Reviewed On Date ^{back to top}

09/19/2008

Medicare Coverage Database

LCD for Rheumatoid Factor (L867)