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Note: New report format as of 2016 Quarter 4 report.

Report Title: Policy Group Map

Report Objective:The purpose of this report is to identify the HCPCS codes within each policy group.  The report consists of two tabs: (1) Policy Group Map – lists HCPCS codes in alpha-numeric order; (2) Print Pages by Policy Group – lists HCPCS codes by Policy Group.  In addition to long and short descriptions for each HCPCS code and the policy group to which each HCPCS belongs, the report also includes the HCPCS effective date and any Local Coverage Determinations (LCDs) applicable to the HCPCS code.

Date Report By:
Report is current as of the end date of the quarter.

Sorted By:Tab 1: HCPCS; Tab 2: Policy Group Name, HCPCS

Report Fields:

Field Name(s) Description(s)
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 groupings 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.
LCD – Title The Local Coverage Determination (LCD) number and title 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:
{N/A} in the Policy Group Name field indicates there is no established name for this Policy Group Number.

The list of HCPCS codes is limited to active HCPCS codes. It does not include terminated HCPCS codes.

LCDs listed in the report include both Part A/Part B LCDs and DME LCDs.  The list includes only final and approved LCDs.

Note: New report format as of 2016 Quarter 4 report.

Policy Group Map

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