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J12 MAC Transition
(* = off-site link)
J12 MAC LCD Final Listing
Welcome to the J12 MAC final Local Coverage Determination (LCD) Listing.
Highmark Medicare Services sincerely thanks all those who shared their knowledgeable comments with us. The comments received were invaluable in revising the draft LCDs, originally posted on April 1, 2008, to their current final form.
The fifty-seven (57) LCDs posted for notice as final on May 23, 2008 and three (3) National Coverage Determination (NCD) Coding Articles (see below) will become effective for Part B Delaware, Maryland, and the District of Columbia Metropolitan Area (DCMA) on July 11, 2008. These LCDs will be effective for the other states, and the District of Columbia (DC) Part A, when the respective locale cuts over to J12 MAC. Please see the J12 implementation schedule for details. Until each locale’s cutover date, the current outgoing contractor LCDs remain in effect.
July 1, 2008: The following J12 MAC LCDs have been revised:
L27529 Scanning Computerized Ophthalmic Diagnostic Imaging
L27497 Fluorescein and Indocyanine Green Angiography
L27507 Ophthalmic A and B Scans
Billing and coding articles related to the LCDs, where appropriate, are being developed and will be posted on
July 11th, 2008.
Click here for the NCD Coding and other related articles.
Click here for Self-Administered Drug Exclusions.
Please note that several of the 57 MAC final LCDs describe coverage for services similar to draft LCDs presented to Highmark Medicare Services outgoing contractor CAC and IACs in February of 2008. Therefore, we are also providing the comments and responses received during that comment process. We carefully considered both the outgoing contractor information, and the comments received on the draft MAC J12 LCDs from April 1st through May 15th, when finalizing these policies.
Please click on the link below to access the comment/response document for the MAC final LCDs. You will see that the February 2008 outgoing contractor draft LCD comments are presented first, followed by the draft J12 MAC LCD comments.
Once again, thank you for your time in providing comments on the draft policies.
Click here for the Comment/Response Document.
MAC Policy Number | MAC Policies | Policy Comment |
| L27473 | Approved Drugs and Biologicals | Notice Period Begins 05/23/2008 |
Blepharoplasty/Blepharoptosis | Notice Period Begins 05/23/2008 | |
Blood Glucose Monitoring in a Skilled Nursing Facility (SNF) | Notice Period Begins 05/23/2008 | |
Botulinum Toxin Type A and B | Notice Period Begins 05/23/2008 | |
Cancer Chemotherapeutic Agents | Notice Period Begins 05/23/2008 | |
Cardiovascular Stress Testing | Notice Period Begins 05/23/2008 | |
Cataract Surgery | Notice Period Begins 05/23/2008 | |
Chiropractic Services | Notice Period Begins 05/23/2008 | |
Co-Management of Surgical Procedures | Notice Period Begins 05/23/2008 | |
Complex Cataract Extraction | Notice Period Begins 05/23/2008 | |
Computed Tomographic Angiography of the Chest | Notice Period Begins 05/23/2008 | |
Consultations | Notice Period Begins 05/23/2008 | |
Coverage of Services and Procedures in Nursing Facilities | Notice Period Begins 05/23/2008 | |
Routine Foot Care | Notice Period Begins 05/23/2008 | |
Debridement of Mycotic Nails | Notice Period Begins 05/23/2008 | |
Diagnostic Laryngoscopy | Notice Period Begins 05/23/2008 | |
Monitored Anesthesia Care (MAC) | Notice Period Begins 05/23/2008 | |
Electrocardiography | Notice Period Begins 05/23/2008 | |
End - Diastolic Pneumatic Compression Therapy | Notice Period Begins 05/23/2008 | |
Erythropoiesis Stimulating Agents (ESAs) | Notice Period Begins 05/23/2008 | |
Evaluation and Management Services in a Nursing Facility | Notice Period Begins 05/23/2008 | |
Fluorescein and Indocyanine Green Angiography | Notice Period Begins 05/23/2008 | |
Fundus Photography | Notice Period Begins 05/23/2008 | |
Intraoperative Neurophysiological Testing | Notice Period Begins 05/23/2008 | |
Luteinizing Hormone-Releasing Hormone (LHRH) Analogs | Notice Period Begins 05/23/2008 | |
Magnetic Pelvic Floor Stimulation (MPFS) | Notice Period Begins 05/23/2008 | |
Magnetic Resonance Imaging (MRI) of the Breast | Notice Period Begins 05/23/2008 | |
Moh's Micrographic Surgery | Notice Period Begins 05/23/2008 | |
Non-Invasive Cerebrovascular Arterial Studies | Notice Period Begins 05/23/2008 | |
Non-Invasive Peripheral Venous Studies | Notice Period Begins 05/23/2008 | |
Ophthalmic A and B Scans | Notice Period Begins 05/23/2008 | |
Ophthalmic Biometry for Intraocular Lens (IOL) Power Calculation | Notice Period Begins 05/23/2008 | |
Extended Ophthalmoscopy | Notice Period Begins 05/23/2008 | |
Parathormone (Parathyroid Hormone) | Notice Period Begins 05/23/2008 | |
Paravertebral Facet Joint Nerve Block and Sacroiliac Joint Injection | Notice Period Begins 05/23/2008 | |
Physical Medicine and Rehabilitation Services, PT and OT | Notice Period Begins 05/23/2008 | |
Psychiatric Therapeutic Procedures | Notice Period Begins 05/23/2008 | |
Radiation Therapy Services | Notice Period Begins 05/23/2008 | |
Radiologic Examination of the Chest (CXR) | Notice Period Begins 05/23/2008 | |
Real-Time, Outpatient Cardiac Monitoring | Notice Period Begins 05/23/2008 | |
Removal of Benign or Premalignant Skin Lesions | Notice Period Begins 05/23/2008 | |
Removal of Impacted Cerumen | Notice Period Begins 05/23/2008 | |
Scanning Computerized Ophthalmic Diagnostic Imaging | Notice Period Begins 05/23/2008 | |
Sleep Disorders Testing | Notice Period Begins 05/23/2008 | |
Speech-Language Pathology (SLP) Services: Communication Disorders | Notice Period Begins 05/23/2008 | |
Surgical Treatment of Nails | Notice Period Begins 05/23/2008 | |
Surveillance of Implantable Cardioverter-Defibrillator (ICD), Office, Internet or Non-Internet Based | Notice Period Begins 05/23/2008 | |
Thermotherapies (Minimally Invasive Surgical Techniques [MISTs] for Benign Prostatic Hyperplasia (BPH)) | Notice Period Begins 05/23/2008 | |
Transesophageal Echocardiography (TEE) | Notice Period Begins 05/23/2008 | |
Transthoracic Echocardiography (TTE) | Notice Period Begins 05/23/2008 | |
Speech-Language Pathology (SLP) Services: Dysphagia; Includes VitalStim® Therapy | Notice Period Begins 05/23/2008 | |
Treatment of Varicose Veins of the Lower Extremities | Notice Period Begins 05/23/2008 | |
Trigger Point Injections | Notice Period Begins 05/23/2008 | |
Visual Fields | Notice Period Begins 05/23/2008 | |
Wound Care | Notice Period Begins 05/23/2008 | |
Acute Care: Inpatient, Observation, and Treatment Room Services | Notice Period Begins 05/23/2008 | |
Human Skin Equivalents (HSE) - Use in the Treatment of Chronic Cutaneous Ulcer Wounds | Notice Period Begins 05/23/2008 |