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Policy Group Map

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Report Objective: The purpose of this report is to identify active HCPCS codes within each policy group as well as providing a list of procedure codes terminated within the prior five years. The report consists of three tabs: (1) PG Map – Active Codes – lists active HCPCS codes in alpha-numeric order; (2) Print Pages – Active Codes – lists active HCPCS codes by Policy Group; and (3) PG Map – Terminated Codes – lists HCPCS codes terminated within the prior five years. In addition to long and short descriptions for each HCPCS code and the policy group to which each HCPCS code belongs, the report also includes the HCPCS code effective date (and termination date for tab 3) and any Local Coverage Determinations (LCDs) applicable to the HCPCS code.

Date Report By: Report is current as of the beginning of the quarter.

Sorted By: Tab 1: HCPCS, Tab 2: Policy Group Number, HCPCS, Tab 3: HCPCS

Report Fields:

Report Field Names Descriptions
HCPCS The five-digit alphanumeric HCPCS code for the supplies provided.
HCPCS Short Description The short description of the five-digit HCPCS code for the supplies provided.
HCPCS Long Description The long description of the five-digit HCPCS code for the supplies provided.
Policy Group Number A numeric code that represents a grouping of procedure codes.
Policy Group Name The description of the policy group.
HCPCS Effective Date The most current date on which the procedure code became valid for submission.
HCPCS Termination Date The most current termination date for the identified procedure code.
DME LCD – Title The DME Local Coverage Determination (LCD) number(s) and title(s) applicable to the identified HCPCS code as found in the CMS Medicare Coverage Database (MCD). There may be more than one LCD for a HCPCS code. For HCPCS codes for which this field is blank, no LCD is provided in the MCD
Part A/B LCD – Title The Part A/B Local Coverage Determination (LCD) number(s) and title(s) applicable to the identified HCPCS code as found in the CMS Medicare Coverage Database (MCD). There may be more than one LCD for a HCPCS code. For HCPCS codes for which this field is blank, no LCD is provided in the MCD.

Notes/Comments:

For tabs 1 and 2, the list of HCPCS codes includes only active HCPCS codes from Durable Medical Equipment Coding System (DMECS). For tab 3, the list of HCPCS codes includes only HCPCS codes terminated within the prior five years from Durable Medical Equipment Coding System (DMECS).

The LCDs listed in the report include only final and approved LCDs.

{N/A} in the Policy Group Name field indicates there is no established name for this Policy Group Number.