SUPERCEDED LCD: Centers for Medicare & Medicaid Services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}

L900

LCD Title ^{back to top}
Syphilis Test

Contractor's Determination Number ^{back to top}
96A-0014-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. Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim. 42 CFR 410.28 instructs on hospital or CAH diagnostic services furnished to outpatients. 42 CFR 410.32. Diagnostic tests may only be ordered by a treating physician (or other treating practitioner acting within the scope of their license and Medicare requirements). CMS Manual System, Pub 100-02, Medicare Benefit Policy Manual, Chapter 6, §20.3.1 and 20.3.2 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}
The Venereal Disease Research Laboratory (VDRL) Test and its analogues, Rapid Plasma Reagin (RPR) and Automated Reagin Test (ART), are the standard nontreponemal laboratory tests used for syphilis screening. These tests demonstrate the presence of nontreponemal antibodies frequently present in syphilis-infected patients. A positive nontreponemal test should be followed by a more specific treponemal test such as the Fluorescent Treponemal Antibody absorbed (FTA-ABS) test or Treponema Pallidum Immobilization (TPI). Syphilis testing is performed to: 1. assist in the diagnosis of primary and secondary syphilis 2. confirm primary or secondary syphilis in the presence of syphilitic lesions 3. monitor response to treatment Medicare does not pay for routine screening tests. Medicare covered qualitative syphilis testing (CPT 86592) is indicated only when there are clinical findings of the skin, mucosa, eyes, teeth, cardiovascular system, or central nervous system that suggest syphilitic infection. Quantitative syphilis testing (CPT 86593) is indicated only when there has been a previous positive result of either 86592 or 86781 but is never indicated when 86592 is negative. Confirmatory and specific treponemal testing is indicated only when there has been a previous positive test result of qualitative syphilis testing (86592) and very rarely when clinical disease particularly in the central nervous system (CNS) suggests tertiary syphilitic disease such as meningoencephalitis, tabes dorsalis, or general paresis, despite a negative qualitative test for syphilis (86592). Quantitative syphilis testing (CPT 86593) is indicated in the follow up of previous positive testing at periodic intervals not to exceed semiannually until seronegativity occurs.

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
72x	Clinic-hospital based or independent renal dialysis facility
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	Laboratory-general classification

CPT/HCPCS Codes ^{back to top}

86592	SYPHILIS TEST; QUALITATIVE (EG, VDRL, RPR, ART)
86593	SYPHILIS TEST; QUANTITATIVE
86781	ANTIBODY; TREPONEMA PALLIDUM, CONFIRMATORY TEST (EG, FTA-ABS)

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

042	HUMAN IMMUNODEFICIENCY VIRUS (HIV) DISEASE
054.10 - 054.19	GENITAL HERPES UNSPECIFIED - OTHER GENITAL HERPES
070.30	VIRAL HEPATITIS B WITHOUT HEPATIC COMA ACUTE OR UNSPECIFIED WITHOUT HEPATITIS DELTA
070.54	CHRONIC HEPATITIS C WITHOUT HEPATIC COMA
078.0	MOLLUSCUM CONTAGIOSUM
078.10	VIRAL WARTS UNSPECIFIED
078.11	CONDYLOMA ACUMINATUM
078.19	OTHER SPECIFIED VIRAL WARTS
090.0 - 090.9	EARLY CONGENITAL SYPHILIS SYMPTOMATIC - CONGENITAL SYPHILIS UNSPECIFIED
091.0 - 091.9	GENITAL SYPHILIS (PRIMARY) - UNSPECIFIED SECONDARY SYPHILIS
092.0 - 092.9	EARLY SYPHILIS LATENT SEROLOGICAL RELAPSE AFTER TREATMENT - EARLY SYPHILIS LATENT UNSPECIFIED
093.0 - 093.9	ANEURYSM OF AORTA SPECIFIED AS SYPHILITIC - CARDIOVASCULAR SYPHILIS UNSPECIFIED
094.0 - 094.9	TABES DORSALIS - NEUROSYPHILIS UNSPECIFIED
095.0 - 095.9	SYPHILITIC EPISCLERITIS - LATE SYMPTOMATIC SYPHILIS UNSPECIFIED
096	LATE SYPHILIS LATENT
097.0 - 097.9	LATE SYPHILIS UNSPECIFIED - SYPHILIS UNSPECIFIED
098.0 - 098.89	GONOCOCCAL INFECTION (ACUTE) OF LOWER GENITOURINARY TRACT - GONOCOCCAL INFECTION OF OTHER SPECIFIED SITES
099.0 - 099.9	CHANCROID - VENEREAL DISEASE UNSPECIFIED
104.0	NONVENEREAL ENDEMIC SYPHILIS
111.0	PITYRIASIS VERSICOLOR
131.00 - 131.9	UROGENITAL TRICHOMONIASIS UNSPECIFIED - TRICHOMONIASIS UNSPECIFIED
136.1	BEHCET'S SYNDROME
289.1 - 289.3	CHRONIC LYMPHADENITIS - LYMPHADENITIS UNSPECIFIED EXCEPT MESENTERIC
289.89	OTHER SPECIFIED DISEASES OF BLOOD AND BLOOD-FORMING ORGANS
290.0 - 290.3	SENILE DEMENTIA UNCOMPLICATED - SENILE DEMENTIA WITH DELIRIUM
293.0	DELIRIUM DUE TO CONDITIONS CLASSIFIED ELSEWHERE
294.8	OTHER PERSISTENT MENTAL DISORDERS DUE TO CONDITIONS CLASSIFIED ELSEWHERE
298.9	UNSPECIFIED PSYCHOSIS
310.1	PERSONALITY CHANGE DUE TO CONDITIONS CLASSIFIED ELSEWHERE
322.9	MENINGITIS UNSPECIFIED
323.9	UNSPECIFIED CAUSES OF ENCEPHALITIS, MYELITIS, AND ENCEPHALOMYELITIS
331.0	ALZHEIMER'S DISEASE
331.2	SENILE DEGENERATION OF BRAIN
331.83	MILD COGNITIVE IMPAIRMENT, SO STATED
342.90 - 342.92	UNSPECIFIED HEMIPLEGIA AND HEMIPARESIS AFFECTING UNSPECIFIED SIDE - UNSPECIFIED HEMIPLEGIA AND HEMIPARESIS AFFECTING NONDOMINANT SIDE
350.1 - 352.9	TRIGEMINAL NEURALGIA - UNSPECIFIED DISORDER OF CRANIAL NERVES
356.0	HEREDITARY PERIPHERAL NEUROPATHY
356.9	UNSPECIFIED IDIOPATHIC PERIPHERAL NEUROPATHY
363.20	CHORIORETINITIS UNSPECIFIED
364.00 - 364.11	ACUTE AND SUBACUTE IRIDOCYCLITIS UNSPECIFIED - CHRONIC IRIDOCYCLITIS IN DISEASES CLASSIFIED ELSEWHERE
368.40	VISUAL FIELD DEFECT UNSPECIFIED
368.46	HOMONYMOUS BILATERAL FIELD DEFECTS
368.9	UNSPECIFIED VISUAL DISTURBANCE
377.00 - 377.01	PAPILLEDEMA UNSPECIFIED - PAPILLEDEMA ASSOCIATED WITH INCREASED INTRACRANIAL PRESSURE
377.10	OPTIC ATROPHY UNSPECIFIED
377.30	OPTIC NEURITIS UNSPECIFIED
389.10	SENSORINEURAL HEARING LOSS UNSPECIFIED
389.11	SENSORY HEARING LOSS, BILATERAL
389.12	NEURAL HEARING LOSS, BILATERAL
389.13	NEURAL HEARING LOSS, UNILATERAL
389.14	CENTRAL HEARING LOSS
389.15	SENSORINEURAL HEARING LOSS, UNILATERAL
389.16	SENSORINEURAL HEARING LOSS, ASYMMETRICAL
389.17	SENSORY HEARING LOSS, UNILATERAL
389.18	SENSORINEURAL HEARING LOSS, BILATERAL
389.20	MIXED HEARING LOSS, UNSPECIFIED
389.21	MIXED HEARING LOSS, UNILATERAL
389.22	MIXED HEARING LOSS, BILATERAL
389.7	DEAF, NONSPEAKING, NOT ELSEWHERE CLASSIFIABLE
389.8	OTHER SPECIFIED FORMS OF HEARING LOSS
389.9	UNSPECIFIED HEARING LOSS
424.1	AORTIC VALVE DISORDERS
436	ACUTE BUT ILL-DEFINED CEREBROVASCULAR DISEASE
441.4	ABDOMINAL ANEURYSM WITHOUT RUPTURE
447.6	ARTERITIS UNSPECIFIED
462	ACUTE PHARYNGITIS
556.9	ULCERATIVE COLITIS UNSPECIFIED
569.41	ULCER OF ANUS AND RECTUM
569.44	DYSPLASIA OF ANUS
569.49	OTHER SPECIFIED DISORDERS OF RECTUM AND ANUS
573.3	HEPATITIS UNSPECIFIED
581.9	NEPHROTIC SYNDROME WITH UNSPECIFIED PATHOLOGICAL LESION IN KIDNEY
583.9	NEPHRITIS AND NEPHROPATHY NOT SPECIFIED AS ACUTE OR CHRONIC WITH UNSPECIFIED PATHOLOGICAL LESION IN KIDNEY
614.0 - 614.9	ACUTE SALPINGITIS AND OOPHORITIS - UNSPECIFIED INFLAMMATORY DISEASE OF FEMALE PELVIC ORGANS AND TISSUES
615.0 - 615.9	ACUTE INFLAMMATORY DISEASES OF UTERUS EXCEPT CERVIX - UNSPECIFIED INFLAMMATORY DISEASE OF UTERUS
616.0 - 616.9	CERVICITIS AND ENDOCERVICITIS - UNSPECIFIED INFLAMMATORY DISEASE OF CERVIX VAGINA AND VULVA
692.9	CONTACT DERMATITIS AND OTHER ECZEMA UNSPECIFIED CAUSE
693.0	DERMATITIS DUE TO DRUGS AND MEDICINES TAKEN INTERNALLY
695.10	ERYTHEMA MULTIFORME, UNSPECIFIED
695.11	ERYTHEMA MULTIFORME MINOR
695.12	ERYTHEMA MULTIFORME MAJOR
695.13	STEVENS-JOHNSON SYNDROME
695.14	STEVENS-JOHNSON SYNDROME-TOXIC EPIDERMAL NECROLYSIS OVERLAP SYNDROME
695.15	TOXIC EPIDERMAL NECROLYSIS
695.19	OTHER ERYTHEMA MULTIFORME
695.50	EXFOLIATION DUE TO ERYTHEMATOUS CONDITION INVOLVING LESS THAN 10 PERCENT OF BODY SURFACE
695.51	EXFOLIATION DUE TO ERYTHEMATOUS CONDITION INVOLVING 10-19 PERCENT OF BODY SURFACE
695.52	EXFOLIATION DUE TO ERYTHEMATOUS CONDITION INVOLVING 20-29 PERCENT OF BODY SURFACE
695.53	EXFOLIATION DUE TO ERYTHEMATOUS CONDITION INVOLVING 30-39 PERCENT OF BODY SURFACE
695.54	EXFOLIATION DUE TO ERYTHEMATOUS CONDITION INVOLVING 40-49 PERCENT OF BODY SURFACE
695.55	EXFOLIATION DUE TO ERYTHEMATOUS CONDITION INVOLVING 50-59 PERCENT OF BODY SURFACE
695.56	EXFOLIATION DUE TO ERYTHEMATOUS CONDITION INVOLVING 60-69 PERCENT OF BODY SURFACE
695.57	EXFOLIATION DUE TO ERYTHEMATOUS CONDITION INVOLVING 70-79 PERCENT OF BODY SURFACE
695.58	EXFOLIATION DUE TO ERYTHEMATOUS CONDITION INVOLVING 80-89 PERCENT OF BODY SURFACE
695.59	EXFOLIATION DUE TO ERYTHEMATOUS CONDITION INVOLVING 90 PERCENT OR MORE OF BODY SURFACE
696.1	OTHER PSORIASIS AND SIMILAR DISORDERS
696.3	PITYRIASIS ROSEA
697.0	LICHEN PLANUS
704.00	ALOPECIA UNSPECIFIED
707.9	CHRONIC ULCER OF UNSPECIFIED SITE
709.8	OTHER SPECIFIED DISORDERS OF SKIN
710.0	SYSTEMIC LUPUS ERYTHEMATOSUS
713.5	ARTHROPATHY ASSOCIATED WITH NEUROLOGICAL DISORDERS
760.2	MATERNAL INFECTIONS AFFECTING FETUS OR NEWBORN
780.32	COMPLEX FEBRILE CONVULSIONS
780.39	OTHER CONVULSIONS
780.93	MEMORY LOSS
780.97	ALTERED MENTAL STATUS
780.99	OTHER GENERAL SYMPTOMS
781.0	ABNORMAL INVOLUNTARY MOVEMENTS
781.2	ABNORMALITY OF GAIT
781.3	LACK OF COORDINATION
781.6	MENINGISMUS
782.0	DISTURBANCE OF SKIN SENSATION
782.1	RASH AND OTHER NONSPECIFIC SKIN ERUPTION
784.3	APHASIA
784.5	OTHER SPEECH DISTURBANCE
785.6	ENLARGEMENT OF LYMPH NODES
792.0	NONSPECIFIC ABNORMAL FINDINGS IN CEREBROSPINAL FLUID
V01.6	CONTACT WITH OR EXPOSURE TO VENEREAL DISEASES
V08	ASYMPTOMATIC HUMAN IMMUNODEFICIENCY VIRUS (HIV) INFECTION STATUS
V23.2	SUPERVISION OF HIGH-RISK PREGNANCY WITH HISTORY OF ABORTION
V23.41	SUPERVISION OF HIGH-RISK PREGNANCY WITH HISTORY OF PRE-TERM LABOR
V23.49	SUPERVISION OF HIGH-RISK PREGNANCY WITH OTHER POOR OBSTETRIC HISTORY
V23.5	SUPERVISION OF HIGH-RISK PREGNANCY WITH OTHER POOR REPRODUCTIVE HISTORY
V23.7	SUPERVISION OF HIGH-RISK PREGNANCY WITH INSUFFICIENT PRENATAL CARE

Diagnoses that Support Medical Necessity ^{back to top}

N/A

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

V82.9 SCREENING FOR UNSPECIFIED CONDITION

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}

CMD Clinical Laboratory Workgroup

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}

03/30/2004

End Date of Comment Period ^{back to top}

05/13/2004

Start Date of Notice Period ^{back to top}

06/18/2004

Revision History Number ^{back to top}

Revision #15, 10/01/2008
Revision #14, 10/01/2007
Revision #13, 10/01/2006
Revision #12, 10/01/2005
Revision #11, 11/22/2004
Revision #10, 10/01/2004
Revision #9, 08/02/2004
Revision #8, 03/26/2004
Revision #7, 02/16/2004
Revision #6, 11/28/2003
Revision #5, 10/01/2003
Revision #4, 08/28/2002
Revision #3, 11/12/2001
Revision #2, 08/01/2001
Revision #1, 08/15/1999

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 code 569.44. ICD-9 code 695.1 was extended to a 5th digit to now read 695.10, 695.11, 695.12, 695.13, 695.14, 695.15, 695.19, 695.50, 695.51, 695.52, 695.53, 695.54, 695.55, 695.56, 695.57, 695.58, and 695.59. 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 revised the publication numbers for the cited manual references from”100-2” and “100-8” to now read “100-02” and “100-08”. Under ICD-9 Codes That Support Medical Necessity added ICD-9 codes 389.13 and 389.17. ICD-9 code 389.2 was extended to a 5th digit to now read 389.20, 389.21 and 389.22. Verbiage changes were made to the following ICD-9 codes: 389.14, 389.18, and 389.7. 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 deleted section 20.3 to now read sections 20.3.1 and 20.3.2 of the CMS Manual System, Pub 100-2, Medicare Benefit Policy Manual, Chapter 6. Under Bill Type Codes added 73X bill type. Under ICD-9 Codes That Support Medical Necessity added ICD-9 codes 331.83, 780.32, and 780.97. The verbiage was revised for ICD-9 code 323.9. Under Documentation Requirements deleted statements #1, #2, #3, and #5. Under Advisory Committee Meeting Notes added Advisory Committee Meeting Date. This policy was reviewed for annual validation. This revision becomes effective 10/01/2006.

Revision #12, 10/01/2005
Under AMA/CPT & ADA/CDT Copyright Statement changed the copyright date. Under CMS National Coverage Policy verbiage changes made. Deleted CMS Manual System, Pub 100-4, Medicare Claims Processing, Chapter 16, Sections 20-30, 30.0, 40.2, 40.4, 60.1-60.1.2, 60.2-70.11, 80.1, 80.2, 90.1, 100, 100.2-100.4, and 110.3 and CMS Manual Sytem, Pub 100-4, Medicare Claims Processing, Chapter 23, Section 40. Under Revenue Codes changed 0300 to 030X. Under Documentation Requirements changed the verbiage for statement #4. Under Sources of Information and Basis for Decision deleted the reference to the 2002 CPT Physician’s CPT. Under Advisory Committee Meeting Notes changed the verbiage. This revision becomes effective 10/01/2005.

Revision #11, 11/22/2004
Under AMA/CPT and ADA/CDT Copyright Statement section of the policy, deleted the reference to CDT-4 copyright language, as this policy does not contain CDT-4 codes or descriptions. This revision becomes effective 11/22/2004.

Revision #10, 10/01/2004
Under AMA/CPT and ADA/CDT Copyright Statement changed the copyright date from 2003 to 2004. Under CMS National Coverage Policy deleted Change Request 2592. Under ICD-9 Codes That Support Medical Necessity changed the verbiage for ICD-9 codes 293.0, 294.8, and 310.1 due to the revised diagnosis code titles. Corrected a spelling error for ICD-9 verbiage 377.30 to read “optic”. These changes become effective 10/01/2004.

Revision #9, 08/02/2004
Converted Local Medical Review Policy (LMRP) to Local Coverage Determination (LCD). Under CMS National Coverage Policy section of the policy, added 42 CFR 410.28 and Change Request 3010. Deleted IOM citations, CMS Manual System, Pub 100-2, Medicare Benefit Policy, Chapter 8, Section 70.1 and CMS Manual System, Pub 100-4, Medicare Claims Processing, Chapter 16, Section 90.2. Under Indications and Limitations of Coverage and/or Medical Necessity section of the policy, added verbiage discussing reasons for syphilis testing and deleted verbiage under #1 Under ICD-9 Codes That Support Medical Necessity section of the policy, deleted ICD-9 code 790.6 and added ICD-9 codes 070.30, 070.54, 111.0, 136.1, 289.1-289.3, 289.89, 293.0, 294.8, 298.9, 310.1, 322.9, 323.9, 342.90-342.92, 350.1-352.9, 363.20, 364.00-364.11, 368.40, 368.46, 368.9, 377.00-377.01, 377.10, 377.30, 389.10-389.9, 424.1, 436, 441.4, 447.6, 462, 556.9, 569.41, 569.49, 573.3, 581.9, 583.9, 692.9, 693.0, 695.1, 696.1, 696.3, 697.0, 704.00, 707.9, 709.8, 710.0, 713.5, 780.39, 780.93, 780.99, 781.0, 781.2, 781.3, 781.6, 782.0, 784.3, 784.5, 785.6, 792.0, and v08. Under ICD-9 Codes That Do Not Support Medical Necessity section of the policy, added V82.9. Under Documentation Requirements section of the policy, added statement #5. These changes become effective 08/02/2004.

Revision #8, 03/26/2004
Under AMA/CPT and ADA/CDT Copyright Statement section of the policy added the American Dental Association copyright statement. Under CMS National Coverage Policy section of the policy deleted previously cited sections 10.2, 30.1, 30.2, 30.4, 40.1, 40.7, 50.1, 60, 80.4, and 110 located in CMS Manual System, Pub 100-4, Medicare Claims Processing, Chapter 16. Under Coverage Topic section of the policy deleted diagnostic tests and xrays. Under ICD-9 Codes That Support Medical Necessity section of the policy, deleted V22.1 and added V23.2, V23.41, V23.49, V23.5, V23.7. These changes become effective 03/26/2004.

Revision #7, 02/16/2004
Under ICD-9 Codes That Support Medical Necessity section of the policy, added ICD-9-CM code v 22.1. ICD-9-CM code 614.0-614.9 verbiage changed to read “inflammatory disease of ovary, fallopian tube, pelvic cellular tissue and peritoneum.” These changes become effective 02/16/2004.

Revision #6, 11/28/2003
Under CMS National Coverage Policy section of this policy the manual citations have been changed to reflect the Internet Only Manual (IOM). This change becomes effective 11/28/2003

Revision #5, 10/01/2003
The copyright date was changed under section AMA CPT Copyright Statement. CMS Pub. 100.8, 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 #4, 08/28/2002
Under Type of Bill Code section, Critical Access Hospital (85x) has been added to the policy.

Revision #3 11/12/2001
ICD-9-CM code 782.1 has been added to the ICD-9-CM Codes That Support Medical Necessity Section of this policy. This change will become effective January 1, 2002.

Revision #2 08/01/2001
The ICD-9-CM Codes That Support Medical Necessity section of this policy has been updated to include 790.6 (Other abnormal blood chemistry). This will become effective August 1, 2001.

Revision #1 08/15/1999

This LCD was converted from an LMRP on 2/23/2004

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.

09/03/2007 - This policy was updated by the ICD-9 2007-2008 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}

09/18/2008

Medicare Coverage Database

LCD for Syphilis Test (L900)