Medicare Medical record review CPT codes list

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Line of Business	Jurisdiction	Provider Type	Description	Date Implemented	Date Last Revised
Part B	JN	All Specialties	Allergy Testing 86003 utilization parameter	30-09-2010	N/A
Part B	JN	Excludes Specialties 18, 41 & 49	Amniotic Membrane-Sutureless Placement on the Ocular Surface, deny 65778 when rendering specialty is not 18, 41 or 49	29-06-2015	N/A
Part B	JN	All Specialties	Application of Skin Substitute Grafts for Treatment of DFU and VLU of Lower Extremities, Deny Q4112, Q4113, Q4114, Q4139, Q4145, Q4149, Q4155 as not medically reasonable and necessary	08-09-2015	N/A
Part B	JN	All Specialties	Arthrocentesis Deny 20610 if J7321, J7323-J7327 is denied	27-09-2007	01-01-2015
Part B	JN	All Specialties	Autonomic Function Test Deny 95943 non covered	24-03-2014	N/A
Part B	JN	All Specialties	Bisphosphonates J0897 quantity billed and  procedure to diagnosis	14-10-2013	13-05-2015
Part B	JN	All Specialties	Bisphosphonates J3489 quantity billed and  procedure to diagnosis	01-07-2013	01-01-2014
Part B	JN	All Specialties	Bisphosphonates J3489 utilization parameter	01-07-2013	01-01-2014
Part B	JN	All Specialties	Cardiovascular Nuclear Imaging Studies 78452/78454 utilization parameter	01-01-2010	N/A
Part B	JN	All Specialties	Collagenase (Xiaflex) Deny 54200/54235  when J0775 is denied same date of service	14-05-2014	N/A
Part B	JN	All Specialties	Collagenase (Xiaflex) 20527/26341 utilization parameter	06-04-2015	N/A
Part B	JN	All Specialties	CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing Deny 81227 and 81355 non covered	03-11-2014	N/A
Part B	JN	All Specialties	Destruction Of Paravertebral Facet Joint Nerve (S) Utilization Parameter	26-01-2010	01-01-2012
Part B	JN	All Specialties	Endoscopic Treatment Of Gastroesophageal Reflux Disease (Gerd) Deny 43257, C9724 non covered	12-06-2012	N/A
Part B	JN	All Specialties	Erythropoiesis Stimulating Agents  Deny J0882 or J0886 billed without HCT or HGB	28-02-2002	20-10-2010
Part B	JN	All Specialties	Erythropoiesis Stimulating Agents J0890  Deny non covered	02-05-2013	N/A
Part B	JN	All Specialties	Erythropoiesis Stimulating Agents J0888  Deny if not billed with Modifier EC	13-01-2015	N/A
Part B	JN	All Specialties	Flow Cytometry 88185 utilization parameter	30-09-2010	N/A
Part B	JN	All Specialties	Fundus Photography & SCODI, Deny 92250 billed on the same date of service with 92133, 92134	13-02-2011	N/A
Part B	JN	All Specialties	Fundus Photography & SCODI,Deny 92133 or 92134 billed on the same date of service with 92250 (Modifier 59)	13-02-2011	07-04-2011
Part B	JN	All Specialties	G-CSF (Neupogen, Granix), Deny J1442, J1446 billed with certain codes in range J9000-J9999	25-02-2005	01-01-2014
Part B	JN	All Specialties	Heparin Injection Deny J1642 billed with administration code same date of service	11-11-2011	13-12-2012
Part B	JN	All Specialties	Implantable Miniature Telescope (IMT), Deny 0308T & C1840 based on bene & date of service	11-02-2015	11-02-2015
Part B	JN	All Specialties	Long-Term Wearable Electrocardiographic Monitoring 93228, 93229 utilization parameter	26-10-2012	NA
Part B	JN	All Specialties	Long-Term Wearable Electrocardiographic Monitoring 93268, 93270, 93271, 93272 utilization parameter	26-10-2012	03-12-2013
Part B	JN	All Provider Types	Low Density Lipoprotein (LDL) Apheresis utilization parameter	03-11-2014	N/A
Part B	JN	All Specialties	Magnetic Resonance Angiography (MRA) 72159, 73225, C8931-C8936 Deny non-covered	04-08-2011	N/A
Part B	JN	All Specialties	Manipulation Under Anesthesia, Deny 22505 non-covered	25-01-2010	N/A
Part B	JN	All Specialties	Manipulation Under Anesthesia, Deny 27194 billed on the same date of service with 23700, 24300 or 27570	25-01-2010	N/A
Part B	JN	All Specialties	Molecular Pathology Procedures non- covered see LCD 33703	07-10-2013	01-01-2015
Part B	JN	All Specialties	Monitored Anesthesia Care 01991/01992 with Specific Procedures & QS Modifier	25-01-2010	N/A
Part B	JN	All Specialties	Nerve Conduction Studies & Electromyography 95860-95872, 95885-95887, 95907-95913 utilization parameter	30-07-2014	06-08-2014
Part B	JN	All Specialties	Non-Covered Codes By LCD	13-02-2011	09-09-2015
Part B	JN	All Specialties	Non-Covered Services, Deny 0387T-0391T if not billed in a clinical trial	29-06-2015	N/A
Part B	JN	Ambulance	Non-Emergency Ground Ambulance Services Deny mileage (A0425) if transport denied (A0426-A0429, A0433 OR A0434)	27-10-2009	N/A
Part B	JN	Ambulance	Non-Emergency Ground Ambulance Services, Deny mileage (A0425) if transport denied (A0426 or A0428)	30-06-2009	21-12-2011
Part B	JN	All Specialties	Non-Invasive Evaluation of Extremity Veins Deny 93965 billed on the same date of service with 93970 or 93971	23-01-2011	N/A
Part B	JN	All Specialties	Noninvasive Physiologic Studies Of Upper & Lower Extremity Arteries Deny 93922-93924 billed on the same date of service with 93925, 93926	31-01-2012	N/A
Part B	JN	All Specialties	Ocular Photodynamic Therapy (Opt) With Verteporfin Deny 67221 if J3396 not billed	16-07-2013	N/A
Part B	JN	All Specialties	Ophthalmological Services Deny 92002 or 92004 billed with 92226	02-02-2009	N/A
Part B	JN	All Specialties	Paravertebral Facet Joint Blocks Deny drug codes if joint injection denied	14-12-2009	04-02-2011
Part B	JN	All Specialties	Peripheral Nerve Blocks 64400-64455 utilization parameter	17-03-2014	10-04-2014
Part B	JN	All Specialties	Posterior Tibial Nerve Stimulation (Ptns) 64566 utilization parameter	31-01-2012	N/A
Part B	JN	All Specialties	Qualitative Drug Screening G0431, G0434, or G6058 Deny 82570 or 81003 if billed on the same date of service	25-01-2010	01-06-2015
Part B	JN	All Specialties	Qutenza (Capsaicin) J7335, J7336 Deny if billed without 64999	01-01-2011	01-01-2015
Part B	JN	All Specialties	Rhythm ECG Deny 93042 billed with inpatient or emergency evaluation and management services	23-08-2010	N/A
Part B	JN	All Specialties	Skin Substitutes Non-Covered see LCDs L29279/L29393	30-06-2009	01-01-2015
Part B	JN	All Specialties	Spinal Cord Stimulation for Chronic Pain, 63655  Utilization Parameter overtime	07-02-2015	07-02-2015
Part B	JN	All Specialties	Spinal Cord Stimulation for Chronic Pain 63655, Place of Service Other Than 21, 22, 24	07-02-2015	07-02-2015
Part B	JN	All Specialties	Surgical Management Of Morbid Obesity, Deny 43843, 43886, 43887, 43888 non-covered	13-02-2011	N/A
Part B	JN	All Specialties	Surgical Treatment of Nails 11730, 11732, 11750, 11765 Deny without modifiers TA, T1-T9, FA, F1-F9	11-02-2013	N/A
Part B	JN	All Specialties	Surgical Treatment of Nails 11730/11732 Utilization Parameter	11-02-2013	N/A
Part B	JN	All Specialties	Total Calcium 82310 Phosphorus 84100 utilization parameter	07-04-2008	09-10-2008
Part B	JN	Excluding Specialties 13 & 26	Transcranial Magnetic Stimulation For Major Depressive Disorder Deny 90867, 90868, 90869 if not specialty 13 or 26	07-07-2014	N/A
Part B	JN	All Specialties	Transplantation Immune Cell Function Assay (IMMUKNOW) Deny 86352 non-covered	29-01-2013	N/A
Part B	JN	All Specialties	Tysabri J2323 utilization parameter	09-06-2010	09-12-2011
Part B	JN	All Specialties	Vertebroplasty, Vertebral Augmentation Deny 22510-22515, 22520-22525 billed without 72291-72292	31-03-2014	01-01-2015
Part B	JN	All Specialties	Vertebroplasty, Vertebral Augmentation utilization parameter	31-03-2014	01-01-2015
Part B	FL/US Virgin Islands	Specialties 50, 89, 97	Vestibular Function Tests	30-09-2014	N/A
Part B	JN	All Specialties	Viscosupplementation Therapy for Knee J7321, J7323, J7324, J7325 and J7327 utilization parameter of codes overtime	01-01-2010	11-06-2015
Part B	JN	All Specialties	Viscosupplementation Therapy for Knee J7325 utilization parameter (units billed)	01-01-2010	N/A
Part B	JN	All Specialties	Viscosupplementation Therapy for Knee  J7326 and J7327 lifetime utilization parameter	11-06-2015	N/A
Part B	JN	All Specialties	VISCO and Imaging Modalities, Deny 77012, 77021, 76881, 76882 or 76942 billed on the same date of service with J7321, J7323, J7324, J7325, J7326 or J7327	26-11-2014	01-01-2015
Part B	JN	All Specialties	Wound Debridement Services 97597 utilization parameter	08-06-2012	N/A