New policy effective August 15, 2024
Noridian Healthcare Solutions (Noridian) announced the addition of new ICD-10 codes to expand the scope of medical necessity for CT Perfusion studies. MSN has been involved in a multi-year team effort petitioning Medicare Administrative Contractors (MACs) to broaden medical necessity criteria for coverage of CPT Code 0042T, after many of them denied claims when patients presented with stroke symptoms but were found to be negative for stroke on imaging.
Renee Engle, RCC, RCCIR, MSN-ARC, FRBMA, MSN Sr. Vice President of Client Services, explained, “Previously if the CT study showed a symptomatic patient didn’t have a stroke, the claim was denied as not medically necessary even if treatment decisions were made based on the results of the study, whether positive or negative.”
She continued, “This was an excellent effort involving MSN coding professionals, who were supported by key physicians among our client groups. Those physicians provided the clinical argument and scientific evidence to argue for payment of CT Perfusion studies based on the analysis of stroke symptoms even when negative findings occurred. We also worked in conjunction with the American College of Radiology (ACR) and participated in the research, ongoing communications and persistent follow-up—and the results were successful.”
- States covered by Noridian include: Washington, Oregon, Idaho, Montana, Wyoming, North Dakota, South Dakota, Utah, Arizona, California, and Nevada.
ICD-10 codes approved for CT Perfusion medical necessity include the following:
Medical necessity requirements for CT Perfusion studies were also expanded for Palmetto GBA and Wisconsin Physicians Service (WPS) local coverage determinations as part of this effort.
