Bobbi Buell's Newsletter

Code Changes in National Coverage Decisions

Roberta L. Buell
Roberta L. Buell

Heads up: this issue is from March 27, 2025. Because it covers time-sensitive coding and regulatory topics, some details may have changed since. See the latest issues for current guidance.

This Change Request (CR) aims to provide a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes result from newly available codes, coding revisions to NCDs released separately, or coding feedback received. Previous NCD coding changes appear in ICD-10 quarterly updates, which can be found here, along with other CMS notices implementing new NCD policies. Edits to ICD-10 and other coding updates specific to NCDs will be included in subsequent quarterly releases and individual CRs as appropriate. No policy-related changes are included with the ICD-10 quarterly updates. Any policy-related changes to NCDs continue to be implemented via the current, longstanding NCD process.

These changes, for the most part, are effective April 21, 2025 (random, but whatever), unless otherwise noted.

  1. NCD 80.2 Photodynamic Therapy, NCD 80.2.1 Ocular Photodynamic Therapy, NCD 80.3 Photosensitive Drugs, NCD 80.3.1 Verteporfin--Contractors shall add CPT 92137 as a covered code for this policy, effective January 1, 2025. NOTE: Besides those mentioned in this policy, there are other uses of 92235,92133, 92134, and 92137. The pre-test only needs to appear in the medical record.
  2. NCD 90.2 Next Generation Sequencing (NGS) for Patients with Advanced Cancer--Contractors shall delete CPT 0448U for OncoReveal™ DX Lung and Colon Cancer Assay, effective December 31, 2024. Contractors shall add CPT 0523U for OncoReveal™ CDX, effective January 1, 2025. Contractors shall add TruSight Oncology Comprehensive and its approved indication using HCPCS 81455 from August 21, 2024 - March 31, 2025. Contractors shall add CPT 0543U for TruSight Oncology Comprehensive, effective April 1, 2025. Contractors shall add CPT 0211U for MI Cancer Seek and its approved indications, effective FDA approval on November 5, 2024.
  3. NCD 100.1 Bariatric Surgery for Treatment of Co-morbid Conditions Related to Morbid Obesity---Contractors shall add ICD-10-CM diagnoses E66.812 and E66.813, effective October 1, 2024. 
  4. NCD 110.18 Aprepitant for Chemotherapy-Induced Emesis--Contractors shall add J9076, effective January 1, 2025.Contractors shall end-date J9058, J9059, effective December 31, 2024. 
  5. NCD 110.23 Stem Cell Transplants-- Contractors shall add TOB 13X to allogeneic hematopoietic stem cell transplantation (HSCT) for Myelodysplastic Syndromes (MDS) claims, whatever that means.
  6. NCD 210.3 Colorectal Cancer Screening Tests--Contractors shall end-date G0106, G0120, G0122, effective December 31, 2024. Contractors shall add coverage for screening CT colonography CPT 74263, effective January 1, 2025, and ensure coinsurance and deductible are waived. Contractors shall remove stool-based language (whatever that may be) from policy to allow for all non-invasive CRC screening tests. Contractors shall add Cologuard Plus™ CPT 0464U, effective on October 3, 2024, due to FDA approval. Contractors shall add CPT 0537U for colorectal cancer screening. Shield™ effective April 1, 2025. FDA approval July 26, 2024. Contractors shall reinstate K codes that were inadvertently removed from the ICD-10-CM dx tab in CRs 13391 and 13828, effective October 1, 2015. Wait, what? Are they just noticing this now?
  7. NCD 250.3 Intravenous Immune Globulin for the Treatment of Auto-Immune Mucocutaneous Blistering Diseases--Contractors shall add HCPCS J1552 to the coverage policy, effective January 1, 2025. 
  8. NCD 110.24 CAR-T Cell Therapy--Contractors shall end date CPT codes 0537T, 0538T, 0539T, and 0540T, effective December 31, 2024. Contractors shall add CPT codes 38225, 38226, 38227, and 38228 effective January 1, 2025. Contractors shall add coverage of Obe-cel/Aucatzyl®, effective FDA approval date of November 8, 2024. Contractors shall use ICD-10 PCS codes XW0338A and XW0438A, HCPCS codes J3490, J3590, J9999, C9399, and corresponding ICD-10 dx codes C83.50-C83.59, C91.00, C91.02. Add additional ICD-10 dx for Abecma® and Carvykti™ based on NCCN indications - ICD-10 dx C90.10, C90.12, C90.20, C90.22, C90.30, C90.32, Z85.79, effective their respective FDA approval dates. 
  9. NCD 160.18 Vagus Nerve Stimulation (VNS)--Contractors shall add ICD-10 diagnosis code G47.33 obstructive sleep apnea to the list of covered indications for 64568 Vagus Nerve Stimulation retroactive January 1, 2025. 

 

For additional information, please see the Transmittal.

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