Corporate

Additional Information Regarding NCD 80.11 – Vitrectomy

In response to inquiries CGS has received regarding the Vitrectomy national coverage determination (NCD) (see NCD Manual section 80.11) implementation instructions to remove certain diagnosis codes (see change request (CR) 10318, Transmittal (TR) 2005, dated January 18, 2018 (a correction to the initial CR 10318, TR 1975 dated November 9, 2017).

The Centers for Medicare & Medicaid Services (CMS) carefully reviews all coding revisions. While the review of the Vitrectomy NCD is no exception, we realize that a large number of codes were removed and that has caused some concern among stakeholders. We appreciate all the stakeholders' comments that notified CMS of the effect of the coding changes. As a result, CMS is in the process of a subsequent review of the codes marked for removal in CR 10318.

In the interim, codes included in the covered diagnosis list prior to CR 10318 are coverable. The CMS Medicare Administrative Contractors (MACs) have been notified of this decision. Any claims you and/or the MACs believe were processed in error as a result of CR 10318 will be reprocessed. Further, if you were advised by a MAC to hold NCD 80.11 claims until further notice, please be assured you can submit those claims and they will be processed without regard to CR 10318.

Once CMS has completed its re-review of coding for NCD 80.11 and if changes to CR 10318 are warranted, it will release a subsequent CR as well as directions to its MACs indicating that decision, complete with specific implementation instructions.

Thank you for your patience as we work through this coding issue with NCD 80.11.

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