Recently, WPS providers in Jurisdiction J5 and J8 began receiving denials of Medical Necessity on G codes submitted to Medicare for IHC stains performed on or after 8/1/2014. After further review, the culprit was identified…Local Coverage Determination (LCD) #L33219.
Labeled “Molecular Diagnostic Testing”, this LCD erroneously linked the G0461 and G0462 as medically necessary ONLY for the following three conditions: V16.0 (family history of malignant neoplasm of gastrointestinal tract), V84.04 (genetic susceptibility to other malignant neoplasm of endometrium), and V84.09 (genetic susceptibility to other malignant neoplasm).
WPS will be issuing a revision to the LCD that will be posted to its website by Oct 1, as well as reprocessing claims that were inappropriately denied since August 1. The mass reprocessing should take place around the end of September.
WPS Jurisdiction J5 and J8 is the Medicare Administrator for these following states: Iowa, Kansas, Missouri, Nebraska, Michigan, and Indiana.
Ann Lambrix is the Executive Client Administrator at Vachette Pathology, your go-to source for industry updates and changes. Visit our website for at www.vachettepathology.com or call us at 517.486.4262.