Lumbar MRI LCD Diagnosis Corrections

Palmetto has identified certain ICD-9 codes were not in the system correctly. There may be some situations where underpayments and overpayments have been erroneously made since October 1, 2008. Applies To Procedure Codes 72148, 72149, 72158 and Q9953 Modifiers 72148 Global, TC and 26 72149 Global, TC and 26 72158 Global, TC and 26 Remark/Reason Codes 50 ñ These are non-covered services because this is deemed a ’medical necessity’ by the payer. N115 ñ This decision was based on a Local Medical Review Policy (LMRP) or LCD. An LMPR/LCD provides a guide to assist in determining whether a particular item or service is covered. A copy of this policy is available at www.cms.hhs.gov/mcd. If you do not have Web access, you may contact the Contractor to request a copy of the LMPR/LCD. MAC Action The system has been corrected and a mass adjustment is being performed. No provider action is required at this time.