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

Policy Group Map

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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; (3) HCPCS to 855S Crosswalk – provides a crosswalk of, as developed by PDAC, procedure codes to product and service codes as well as a field indicating if the procedure code requires accreditation.  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 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; Tab 3: HCPCS, Product and Service Code

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.
DME LCD – Title The DME 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.
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.
Product and Service Code An alphanumeric code representing a category of products and services.
Product and Service Code Description The description of the alphanumeric product and service code.
Requires Accreditation (Y/N) Indicating (Y/N) if the identified HCPCS code requires accreditation per Change Requests (CR) 6556/7333/9371/9904.
Crosswalk Effective Date The effective date of the crosswalk.
Crosswalk End Date The end date, if applicable, of the crosswalk.

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.

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

On tab 3, a HCPCS code can be crosswalked to multiple Product and Service Codes. For these situations, a separate row is provided for each combination. HCPCS codes with a missing Product and Service Code do not have an active crosswalk.