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How to find the Medicare coverage policy that applies to you.

How to find the Medicare coverage policy that applies to you.

This article teaches you how to locate either a Local Coverage Determination (LCD) or coverage article on hyperbaric oxygen therapy. Centers for Medicare and Medicaid Services (CMS) has a Medicare Coverage Database where you can search for LCDs and coverage articles from your Medicare Administrative Contractor (MAC). The website for this database is: http://www.cms.gov/medicare-coverage-database/. The webpage should look like the image below.

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At the top of this screen, choose the tab labeled “Advanced Search”.

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Under “Search by Document Type”, select “Local Coverage Documents”. Then select “All Local Coverage”. Then select your State. For this example, “Alabama” was chosen.

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Scroll the window down, select “Keyword(s)”, and type in a search word. For this example, the word “hyperbaric” is used. If you know the CPT/HCPCS code of the procedure, you can alternatively select “CPT/HCPCS” and enter the code.

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Select “Search by Type” at the bottom of the window. A list of documents meeting your search criteria will appear. In the example below, the only document found was a coverage article titled “NCD – Hyperbaric Oxygen Therapy (HBO)” (A48900).

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To read the article, select the plus sign on the left. It will reveal 2 copies of the same article. The documents are identical, but the MAC has 2 different contractor numbers so the document is listed under each of the 2 contractor numbers.

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Select either of the 2 Article ID numbers on the left to read the document. When you select the number, a screen titled “License Agreements” will appear. Scroll the window to the bottom and select “Accept”.

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The LCD should be open for you to read, print, or convert to a PDF file.

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If you select Kentucky or Ohio as your State, there is no specific coverage guidance available for hyperbaric oxygen therapy. The only information provided is the National Coverage Determination for Hyperbaric Oxygen Therapy (NCD 20.29).

If you select Indiana, Iowa, Kansas, Michigan, Missouri, or Nebraska as your State, there is no LCD or article available. The Wisconsin Physician Services (WPS) website does have a list of documentation requirements. Click here to view this information.

Illinois, Michigan, and New Jersey currently have a Medicare requirement for prior authorization of non-emergent hyperbaric oxygen therapy. You can find details about this requirement on the CMS website at the following link: http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Prior-Authorization-Initiatives/Prior-Authorization-of-Non-emergent-Hyperbaric-Oxygen.html

Author:
Robert B. Sheffield, BA, CHT
Director of Education
International ATMO, Inc.

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