Where can I find coverage criteria for a specific HCPCS code or item?
Refer to the appropriate Local Coverage Determination (LCD) or Policy Article for information on the coverage criteria for that code or item as well as documentation requirements. A link to the Jurisdiction C LCDs and Policy Articles can be found in the Coverage and Pricing section of our website.
Related Questions
- Do NDCs eliminate the need for providers to describe the drugs used with a HCPCS Level III code such as Z7610 (miscellaneous drugs) or a procedure code such as 90779 (therapeutic injection) in the Reserved for Local Use field (Box 19) on the CMS-1500 claim form?
- If a provider enters the HCPCS Level I, II or III code, units and/or NDC correctly, but does not enter the unit of measurement correctly, will that line item be denied?
- What HCPCS code(s) should be used to bill ABRAXANE?
