LCD or Medical Policy 2

The rules by which a chart is judged during a Medicare audit 3

LCDs Medicare Part B, Active Google: “(carrier name) Part B LCDs” 4

Download: Current, Retired, & Articles Print, keep in binder Download NCDs too 5

Nordian: (active Sep 2013) NonCovered ServiceGonioscopy (ret.) BotulinumBlepharoplasty (ret.) YAG for 2°Cataract (ret.) EO & Fundus Photo (ret.) Skin LesionTopography (ret.) Ophthal. Services (ret.) Scanning Image (OCT) (ret.) Pachymetry (ret.) VF (ret.) 6

CGS: (active Sep 2013) BlepharoplastyPunctum Dilate-Probe BotulinumPhoto, External YAG for 2°CataractBiometry for IOL Cataract SurgeryEO & Fundus Photo Category 3 CPTsSkin Lesion TopographyScanning Image (OCT) PachymetryVF 7

WPS: (active Sep 2013) BlepharoplastyLow Vision BotulinumVF Implant Telescope (ret.) Biometry for IOL (ret.) Cataract Surgery (ret.) EO & Fundus Photo (ret.) Category 3 CPTsSkin Lesion Topography (ret.) Scanning Image (OCT) Pachymetry (ret.) 8

Novitas: (active Sep 2013) BlepharoplastyA & B Scan CoManage SurgeryVF E/M in SNFVision Rehab Cataract SurgeryEO Biometry for IOLSkin Lesion Not Reasnble & NecssryScanning Image (OCT) Fundus Photo 9

Palmetto: (active Sep 2013) Blepharoplasty Category 3 CPTs Cataract Surgery EO & Fundus Photo Skin Lesion Pachymetry 10

DME: (active Sep 2013) Refractive Lenses Google: “(carrier name) DME LCD refractive lenses” 11

Provides Limitations on frequency, Indications - medical conditions that are covered, 12

Provides Documentation Requirements - what must be in chart notes, ICDs which will show medical necessity 13

Not necessarily good Can change or retire any time 14

Retired policies can be useful if no other guide can be found 15

NCDs Medicare National Coverage Determinations Google “Medicare NCDs” 16

GLAUCOMA file://localhost/Users/alanhomestead/Doc uments/My Documents B /Adventures /O - S/Presentations/Repository of My PowerPoints/1 Topic Modules/Glaucoma/Glc Aug 13.ppt 17