Medicare National Coverage Determinations Manual

Medicare National Coverage Determinations Manual

Chapter 1, Part 3 (Sections 170 ? 190.34) Coverage Determinations

Table of Contents (Rev. 11892, 03-09-23)

Transmittals for Chapter 1, Part 3

170 - Nonphysician Practitioner Services (PT/OT/SLP/Audiologists/CRNA) 170.1 - Institutional and Home Care Patient Education Programs 170.2 - Melodic Intonation Therapy 170.3 - Speech -Language Pathology Services for the Treatment of Dysphagia

180 - Nutrition 180.1 - Medical Nutrition Therapy (MNT) 180.2 - Enteral and Parenteral Nutritional Therapy (RETIRED)

190 - Pathology and Laboratory 190.1 - Histocompatibility Testing 190.2 - Diagnostic Pap Smears 190.3 - Cytogenetic Studies 190.4 - Electron Microscope (RETIRED) 190.5 - Sweat Test 190.6 - Hair Analysis 190.7 - Human Tumor Stem Cell Drug Sensitivity Assays 190.8 - Lymphocyte Mitogen Response Assays 190.9 - Serologic Testing for Acquired Immunodeficiency Syndrome (AIDS) 190.10 - Laboratory Tests - CRD Patients 190.11 - Home Prothrombin Time/International Normalized Ratio (PT/INR) Monitoring for Anticoagulation Management ? (Effective March 19, 2008) 190.12 - Urine Culture, Bacterial 190.13 - Human Immunodeficiency Virus (HIV) Testing (Prognosis Including Monitoring) 190.14 - Human Immunodeficiency Virus (HIV) Testing (Diagnosis) 190.15 - Blood Counts 190.16 - Partial Thromboplastin Time (PTT)

190.17 - Prothrombin Time (PT) 190.18 - Serum Iron Studies 190.19 - Collagen Crosslinks, Any Method 190.20 - Blood Glucose Testing 190.21 - Glycated Hemoglobin/Glycated Protein 190.22 - Thyroid Testing 190.23 - Lipid Testing 190.24 - Digoxin Therapeutic Drug Assay 190.25 - Alpha-fetoprotein 190.26 - Carcinoembryonic Antigen 190.27 - Human Chorionic Gonadotropin 190.28 - Tumor Antigen by Immunoassay ? CA 125 190.29 - Tumor Antigen by Immunoassay CA 15-3/CA 27.29 190.30 - Tumor Antigen by Immunoassay CA 19-9 190.31 - Prostate Specific Antigen 190.32 - Gamma Glutamyl Transferase 190.33 - Hepatitis Panel/Acute Hepatitis Panel 190.34 - Fecal Occult Blood Test

170 - Nonphysician Practitioner Services (PT/OT/SLP/Audiologists/CRNA

(Rev. 1, 10-03-03)

170.1 - Institutional and Home Care Patient Education Programs

(Rev. 1, 10-03-03) CIM 80-1

While the Act does not specifically identify patient education programs as covered services, reimbursement may be made under Medicare for such programs furnished by providers of services (i.e., hospitals, SNFs, HHAs, and OPT providers) to the extent that the programs are appropriate, integral parts in the rendition of covered services which are reasonable and necessary for the treatment of the individual's illness or injury. For example, educational activities carried out by nurses such as teaching patients to give themselves injections, follow prescribed diets, administer colostomy care, administer medical gases, and carry out other inpatient care activities may be reimbursable as a part of covered routine nursing care. Also, the teaching by an occupational therapist of compensatory techniques to improve a patient's level of independence in the activities of daily living may be reimbursed as a part of covered occupational therapy. Similarly, the instruction of a patient in the carrying out of a maintenance program designed for him/her by a physical therapist may be reimbursed as part of covered physical therapy.

However, when the educational activities are not closely related to the care and treatment of the patient, such as programs directed toward instructing patients or the public generally in preventive health care activities, reimbursement cannot be made since the Act limits Medicare payment to covered care which is reasonable and necessary for the treatment of an illness or injury. For example, programs designed to prevent illness by instructing the general public in the importance of good nutritional habits, exercise regimens, and good hygiene are not reimbursable under Medicare.

170.2 - Melodic Intonation Therapy

(Rev. 1, 10-03-03) CIM 35-67

Melodic intonation therapy is a technique used in language rehabilitation. Its purpose is to teach aphasic patients to produce useful phrases by intoning them in a melodic pattern with strong rhythmic support. Limited studies by a few institutions show some benefit for a small number of nonfluent aphasic patients otherwise unresponsive to conventional therapy.

Melodic intonation therapy is a covered service only for nonfluent aphasic patients unresponsive to conventional therapy, and only when the conditions for coverage of speech pathology services are met. Please refer to the Medicare Benefit Policy, Chapter 15, "Covered Medical and Other Health Services," ?220; the Medicare Claims Processing Manual, Chapter 5, "Part B Outpatient Rehabilitation and CORF Services," for these conditions of coverage.

170.3 - Speech -Language Pathology Services for the Treatment of Dysphagia

(Rev. 55, Issued: 05-05-06, Effective: 10-01-06, Implementation: 10-02-06)

Dysphagia is a swallowing disorder that may be due to various neurological, structural, and cognitive deficits. Dysphagia may be the result of head trauma, cerebrovascular accident, neuromuscular degenerative diseases, head and neck cancer, or encephalopathies. While dysphagia can afflict any age group, it most often appears among the elderly. Speech-language pathology services are covered under Medicare for the treatment of dysphagia, regardless of the presence of a communication disability.

Patients who are motivated, moderately alert, and have some degree of deglutition and swallowing functions are appropriate candidates for dysphagia therapy. Elements of the therapy program can include thermal stimulation to heighten the sensitivity of the swallowing reflex, exercises to improve oral-motor control, training in laryngeal adduction and compensatory swallowing techniques, and positioning and dietary modifications. Design all programs to ensure swallowing safety of the patient during oral feedings and maintain adequate nutrition.

Cross-reference:

The Medicare Benefit Policy, Chapter 15, "Covered Medical and Other Health Services," ??220 and 230.3.

180 - Nutrition

(Rev. 1, 10-03-03)

180.1 - Medical Nutrition Therapy (MNT)

(Rev. 11426; Issued: 05-20-22; Effective: 01-01-22; Implementation: 07-05-22)

A. General

Section 1861(s)(2)(V) of the Social Security Act authorizes Medicare part B coverage of medical nutrition therapy services (MNT) for certain beneficiaries who have diabetes or a renal disease. Regulations for MNT were established on January 2, 2002, at 42 CFR 410.130 - 410.134. This national coverage determination (NCD) establishes the duration and frequency limits for the MNT benefit and coordinates MNT and diabetes outpatient self-management training (DSMT) as an NCD.

B. Nationally Covered

Effective January 1, 2022, basic coverage of MNT, for the first year a beneficiary receives MNT, with either a diagnosis of renal disease or diabetes as defined at 42 CFR 410.130 is three hours of administration. Basic coverage in subsequent years for renal disease or diabetes is two hours. The dietitian/nutritionist may choose how

many units are administered per day as long as all of the other requirements in this NCD and 42 CFR 410.130-410.134 are met. Pursuant to the exception at 42 4CFR 410.132(b)(5), additional hours are considered to be medically necessary and covered if the physician determines that there is a change in medical condition, diagnosis, or treatment regimen that requires a change in MNT and orders additional hours during that episode of care.

If the physician determines that receipt of both MNT and DSMT is medically necessary in the same episode of care, Medicare will cover both DSMT and MNT initial and subsequent years without decreasing either benefit as long as DSMT and MNT are not provided on the same date of service. The dietitian/nutritionist may choose how many units are performed per day as long as all of the other requirements in the NCD and 42 CFR 410.130-410.134 are met. Pursuant to the exception at 42 CFR 410.132(b)(5), additional hours are considered to be medically necessary and covered if the physician determines that there is a change in medical condition, diagnosis, or treatment regimen that requires a change in MNT and orders additional hours during that episode of care.

C. Nationally Non-Covered

N/A

D. Other

N/A

(This NCD last reviewed December 2021.)

180.2 - Enteral and Parenteral Nutritional Therapy (RETIRED)

(Rev. 11892; Issued: 03-09-23; Effective: 04-10-23; Implementation:04-10-23)

Effective January 1, 2022, the Centers for Medicare & Medicaid Services determined that no national coverage determination (NCD) is appropriate at this time for Enteral and Parenteral Nutritional Therapy. In the absence of an NCD, coverage determinations will be made by the Medicare Administrative Contractors under 1862(a)(1)(A) of the Social Security Act.

190 - Pathology and Laboratory

(Rev. 1, 10-03-03)

190.1 - Histocompatibility Testing

(Rev. 1, 10-03-03) CIM 50-23

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