CMS recently released Transmittal 13809 that updates the Medicare Claims Processing Manual and contains coding revisions to National Coverage Determinations (NCDs) relevant to radiology. Revisions include:
NCD 210.3 Colorectal Cancer Screening Tests
Medicare Administrative Contractors (MACs) are instructed to add International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) diagnosis codes:
- Z83.718 - Family history of other colon polyps
- Z15.060 - Genetic susceptibility to colorectal cancer
- Z15.068 - Genetic susceptibility to other malignant neoplasm of digestive system
NCD 220.4 Mammograms
MACs are instructed to add ICD-10-CM diagnosis codes:
- C50.A1 - Malignant inflammatory neoplasm of right breast
- C50.A2 - Malignant inflammatory neoplasm of left breast
- Z84.A - Family history of exposure to diethylstilbestrol
- Z91.B - Personal risk factor of exposure to diethylstilbestrol
NCD 220.6.17 PET for Oncologic Conditions
MACs are instructed to add ICD-10-CM diagnosis codes:
- C50.A1
- C50.A2
- Z85.4A - Personal history of malignant neoplasm of fallopian tube(s)
NCD 220.13 Percutaneous Image-Guided Breast Biopsy
MACs are instructed to add ICD-10-CM diagnosis codes:
CMS also released Transmittal 13752 that includes coding revisions affecting Bone (Mineral) Density Studies.
NCD 150.3 Bone (Mineral) Density Studies
CMS added the following codes as payable services retroactive to Jan. 1, 2024. These codes are covered only for diagnostic indications and not for monitoring. CMS also instructs contractors to waive beneficiary co-insurance and deductible requirements for CPT® codes 0554T–0558T.
- 0554T - Bone strength and fracture risk using finite element analysis of functional data and bone-mineral density utilizing data from a computed tomography scan; retrieval and transmission of the scan data, assessment of bone strength and fracture risk and bone-mineral density, interpretation and report.
- 0555T - Bone strength and fracture risk using finite element analysis of functional data and bone-mineral density utilizing data from a computed tomography scan; retrieval and transmission of the scan data.
- 0556T - Bone strength and fracture risk using finite element analysis of functional data and bone-mineral density utilizing data from a computed tomography scan; assessment of bone strength and fracture risk and bone-mineral density.
- 0557T - Bone strength and fracture risk using finite element analysis of functional data and bone-mineral density utilizing data from a computed tomography scan; interpretation and report.
- 0558T - Computed tomography scan taken for the purpose of biomechanical computed tomography analysis.
The transmittal also updates sections of the Medicare Claims Processing Manual related to radiology services, including payment for low osmolar contrast material (LOCM), billing and coverage changes for PET scans, and HCPCS and diagnosis coding requirements for mammography services. See Transmittals 13809 and 13752 for additional details.
ACR® encourages practices to review the updates and revisions and make any necessary system changes.
If you have questions about the NCD process or coding revisions, contact Alicia Blakey, ACR Manager, Economic Policy, or Maria Tran, ACR Director of Economic Policy.
