LCD : Removal Impacted Cerumen (L1597)

LCD for Removal Impacted Cerumen (L1597)

Contractor Information

Contractor Name

BlueCross BlueShield of Tennessee (Riverbend Government Benefits Administrator)

Contractor Number

00390

Contractor Type

LCD Information

LCD ID Number

L1597

LCD Title

Removal Impacted Cerumen

Contractor's Determination Number

1597

AMA CPT / ADA CDT Copyright Statement

CPT codes, descriptions and other data only are copyright 2007 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

CMS National Coverage Policy

Title XVIII of the Social Security Act, Section 1862 (a)(1)(A). This section excludes coverage of items or services that are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Title XVIII of the Social Security Act, Section 1862 (a)(7). This section prohibits Medicare payment for any expenses on items and services incurred for routine physical examinations.

Title XVIII of the Social Security Act, Section 1833 (e). This section prohibits Medicare payment for any claim that lacks the necessary information to process the claim.

Primary Geographic Jurisdiction

New Jersey
Tennessee

Secondary Geographic Jurisdiction

Alaska
Alabama
Arkansas
Arizona
California
Colorado
Connecticut
Florida
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
North Carolina
North Dakota
Nebraska
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming

Oversight Region

Region IV

Original Determination Effective Date

For services performed on or after 12/27/1996

Original Determination Ending Date

Revision Effective Date

For services performed on or after 07/28/2005

Revision Ending Date

Indications and Limitations of Coverage and/or Medical Necessity

Impacted cerumen removal is the extraction of hardened or an accumulation of cerumen from the external auditory canal by mechanical means, such as irrigation or scraping.

Medicare will provide coverage for removal impacted cerumen which is medically necessary based on ICD-9 submission.

Coverage Topic

Outpatient Hospital Services

Coding Information

Bill Type Codes:

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

Revenue Codes:

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

036X	Operating room services-general classification
045X	Emergency room-general classification
049X	Ambulatory surgical care-general classification
076X	Treatment or observation room-general classification
094X	Other therapeutic services-general classification

CPT/HCPCS Codes

69210

REMOVAL IMPACTED CERUMEN (SEPARATE PROCEDURE), ONE OR BOTH EARS

ICD-9 Codes that Support Medical Necessity

380.4

IMPACTED CERUMEN

Diagnoses that Support Medical Necessity

ICD-9 Codes that DO NOT Support Medical Necessity

ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation

Diagnoses that DO NOT Support Medical Necessity

General Information

Documentation Requirements

Medical documentation for all services covered by Medicare is expected to indicate the clear and concise medical necessity. If documentation is requested, submit:

M.D. orders/progress notes
Procedure documentation
Itemization of charges

Appendices

LINK TO QUESTIONS AND ANSWERS (COMMENTS) ABOUT THIS
POLICY:
Frequently Asked Questions

Utilization Guidelines

Sources of Information and Basis for Decision

Other contractor policy

Advisory Committee Meeting Notes

This policy does not reflect the sole opinion of the contractor or contractor medical director. Although the final decision rests with the contractor, this policy was developed in cooperation with advisory groups, which includes representatives from appropriate specialties as well as provider (facility) representatives.

Start Date of Comment Period

End Date of Comment Period

Start Date of Notice Period

11/27/1996

Revision History Number

1597a

Revision History Explanation

07/242002 Formatted

11/07/2000 Checked ICD-9 codes with ICD-9 2001 code book-No changes made

02/21/2001 Checked CPT codes with CPT Code Book 2001-No changes made

This LCD was converted from an LMRP on 7/27/2005

10/30/2007 - Frequently Asked Questions restored to Appendices

Reason for Change

Other

Last Reviewed On Date

10/30/2007

Related Documents

Article(s)
A35162 - Removal Impacted Cerumen

LCD Attachments

FAQ - Comment and Response (871 bytes)

Other Versions

Updated on 09/01/2006 with effective dates 07/28/2005 - N/A

Updated on 07/27/2005 with effective dates 07/28/2005 - N/A

Updated on 07/27/2005 with effective dates 07/24/2002 - 07/27/2005

Updated on 03/11/2003 with effective dates 07/24/2002 - N/A

Updated on 10/04/2002 with effective dates 07/24/2002 - N/A