Medicare Part B local coverage determination (LCD) comment summary
LCD Number
62263
Contractor Name
First Coast Service Options, Inc.
Contractor Number
09102 -
09202 - Puerto Rico
09302 -
Contractor Type
MAC Part B
LCD Title
Endoscopic and Percutaneous Lysis of Epidural Adhesions
AMA CPT Copyright Statement
CPT codes, descriptions, and other data only are copyright 2008 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply.
Start Date of Comment Period:
06/01/2009
End Date of Comment Period:
07/15/2009
Comments received:
Comment #1: The endoscopic and percutaneous lysis of adhesions LCD should also provide coverage language for the cervical spine. It is a procedure that is useful in the cervical or thoracic regions for radicular type problems and this draft LCD, as written, strongly emphasizes the lumbar spine only.
Contractor response: Medical literature reviewed supports the use of lysis of adhesions for the cervical and thoracic regions. The LCD will be updated to include ICD-9-CM codes that support medical necessity for treatment of the cervical and thoracic regions.
Comment #2: Utilization of this procedure should be limited to once per six months in the same anatomical area.
Contractor response: The addition of utilization guidelines to the LCD at this time will further restrict the LCD. In order to add such restrictions to the LCD a new draft, comment and notice period would be required. Therefore, utilization guidelines can not be added to the current draft of this LCD. However, services exceeding more than one every six months to the same anatomical region may be subject to medical review, and this will be stated in the policy.