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J12 MAC Transition
(* = off-site link)
Welcome to the J12 MAC Draft Local Coverage Determination (LCD) listing.
Highmark Medicare Services plans to fulfill CMS' requirement to consolidate LCDs by the first segment cutover, which is July 11, 2008 for the MD/DCMA/DE Part B workloads. These consolidated LCDs, as well as any claim processing edits, will be effective for all of the other states when that locale cuts over to J12 MAC. CMS has not finalized the implementation schedule for these other locales, but once finalized, Highmark Medicare Services will publish those cutover dates. Until each locale's cutover date, any and all current legacy contractor LCDs and applicable claim processing edits remain in effect.
We look forward to working with the physicians, providers, and facilities as we transition and administer the Medicare Part A and Part B Program in J12.
For complete details, including instructions for the comment process, click here.
MAC Policy Number | MAC Policies | Policy Comment |
Approved Drugs and Biologicals | ||
Blepharoplasty/Blepharoptosis | ||
Blood Glucose Monitoring in a Skilled Nursing Facility (SNF) | ||
Botulinum Toxin Type A and B | ||
Cancer Chemotherapeutic Agents | ||
Cardiovascular Stress Testing | ||
Cataract Surgery | ||
Chiropractic Services | ||
Co-Management of Surgical Procedures | ||
Complex Cataract Extraction | ||
Computed Tomographic Angiography of the Chest | ||
Consultations | ||
Coverage of Services and Procedures in Nursing Facilities | ||
Routine Foot Care | ||
Debridement of Mycotic Nails | ||
Diagnostic Laryngoscopy | ||
Monitored Anesthesia Care (MAC) | ||
Electrocardiography | ||
End - Diastolic Pneumatic Compression Therapy | ||
Erythropoiesis Stimulating Agents (ESAs) | ||
Evaluation and Management Services in a Nursing Facility | ||
Fluorescein and Indocyanine Green Angiography | ||
Fundus Photography | ||
Intraoperative Neurophysiological Testing | ||
Luteinizing Hormone-Releasing Hormone (LHRH) Analogs | ||
Magnetic Pelvic Floor Stimulation (MPFS) | ||
Magnetic Resonance Imaging (MRI) of the Breast | ||
Moh's Micrographic Surgery (MMS) | ||
Non-Invasive Cerebrovascular Arterial Studies | ||
Non-Invasive Peripheral Venous Studies | ||
Ophthalmic A and B scans | ||
Ophthalmic Biometry for Intraocular Lens (IOL) Power Calculation | ||
Ophthalmoscopy Extended | ||
Parathormone (Parathyroid Hormone) | ||
Paravertebral Facet Joint Nerve Block and Sacroiliac Joint Injections | ||
Physical Medicine and Rehabilitation Services, PT and OT | ||
Psychiatric Therapeutic Procedures | ||
Radiation Therapy Services | ||
Radiologic Examination of the Chest (CXR) | ||
Real-Time, Outpatient Cardiac Monitoring | ||
Removal of Benign or Premalignant Skin Lesions | ||
Removal of Impacted Cerumen | ||
Scanning Computerized Ophthalmic Diagnostic Imaging | ||
Sleep Disorder Testing | ||
Speech-Language Pathology (SLP) Services | ||
Surgical Treatment of Nails | ||
Surveillance of Implantable Cardioverter-Defibrillator (ICD), Office, Internet or Non-Internet Based | ||
Thermotherapies (Minimally Invasive Surgical Techniques [MISTs] for Benign Prostatic Hypertrophy (BPH)) | ||
Transesophageal Echocardiography (TEE) | ||
Transthoracic Echocardiography (TTE) | ||
Treatment of Dysphagia (Swallowing Disorders), General; Includes VitalStim® Therapy | ||
Treatment of Varicose Veins of the Lower Extremities | ||
Trigger Point Injections | ||
Visual Fields | ||
Wound Care | ||
| Acute Care: Inpatient, Observation, and Treatment Room Services | ||
Human Skin Equivalents (HSE) - Use in the Treatment of Chronic Cutaneous Ulcer Wounds |