HBO Policies & LCD’s

It’s that time again!!! The 2011 LCD list from CMS (Medicare). If you are not familiar with your LCD (Local Coverage Determination) then maybe the map above should say it all. Reading one of these is basically like trying to navigate a never-ending maze – but that’s not to say that it cannot be done. If you BILL Medicare/CMS for hyperbaric services, you NEED to know the parameters at which to operate your center. Some of the future changes to come include requiring ACLS training for techs and physicians, non-hospital located HBO departments will require a physician in the office suite during hyperbaric treatments. Some of these are already in place in some regions so my advice is to look for your LCD below and “OWN IT”!!! If you are a hyperbaric tech or safety director, or hyperbaric supervisor and want to grow someday – READ, UNDERSTAND, AND SHARE YOUT LCD WITH YOUR PHYSICIANS AND STAFF.

INSTRUCTIONS: Click the link > Agree to the CMS terms > Then your LCD will show > PDF option is on top right of the LCD for download or for printing.

L26567 Hyperbaric Oxygen (HBO) Therapy Wisconsin Physicians Service Insurance Corporation (05301) Nebraska

L26567 Hyperbaric Oxygen (HBO) Therapy Wisconsin Physicians Service Insurance Corporation (05401) Missouri – Entire State

L26567 Hyperbaric Oxygen (HBO) Therapy Wisconsin Physicians Service Insurance Corporation (05101) Iowa

L26567 Hyperbaric Oxygen (HBO) Therapy Wisconsin Physicians Service Insurance Corporation (05201) Kansas

L26598 Hyperbaric Oxygen (HBO) Therapy – 4M-30AB-R3 TrailBlazer Health Enterprises, LLC (04202) New Mexico

L26598 Hyperbaric Oxygen (HBO) Therapy – 4M-30AB-R3 TrailBlazer Health Enterprises, LLC (04102) Colorado

L26598 Hyperbaric Oxygen (HBO) Therapy – 4M-30AB-R3 TrailBlazer Health Enterprises, LLC (04402) Texas

L26598 Hyperbaric Oxygen (HBO) Therapy – 4M-30AB-R3 TrailBlazer Health Enterprises, LLC (04302) Oklahoma

L26598 Hyperbaric Oxygen (HBO) Therapy – 4M-30AB-R3 TrailBlazer Health Enterprises, LLC (04901) Colorado, New Mexico, Oklahoma, Texas

L26598 Hyperbaric Oxygen (HBO) Therapy – 4M-30AB-R3 TrailBlazer Health Enterprises, LLC (04201) New Mexico

L26598 Hyperbaric Oxygen (HBO) Therapy – 4M-30AB-R3 TrailBlazer Health Enterprises, LLC (04101) Colorado

L26598 Hyperbaric Oxygen (HBO) Therapy – 4M-30AB-R3 TrailBlazer Health Enterprises, LLC (04401) Texas

L26598 Hyperbaric Oxygen (HBO) Therapy – 4M-30AB-R3 TrailBlazer Health Enterprises, LLC (04301) Oklahoma

L5140 Hyperbaric Oxygen (HBO) Therapy – M-15B-R7 TrailBlazer Health Enterprises, LLC (00904) Virginia

L29347 Hyperbaric Oxygen Therapy (HBO Therapy) First Coast Service Options, Inc. (09202) Puerto Rico

L29347 Hyperbaric Oxygen Therapy (HBO Therapy) First Coast Service Options, Inc. (09302) Virgin Islands

L29192 Hyperbaric Oxygen Therapy (HBO Therapy) First Coast Service Options, Inc. (09102) Florida

L28887 Hyperbaric Oxygen Therapy (HBO Therapy) First Coast Service Options, Inc. (09101) Florida

L28909 Hyperbaric Oxygen Therapy (HBO Therapy) First Coast Service Options, Inc. (09201) Puerto Rico, Virgin Islands

L25204 Hyperbaric Oxygen Therapy (HBO) National Government Services, Inc. (13292) New York – Queens

L27575 Hyperbaric Oxygen Therapy (HBO) Palmetto GBA (01101)

L25204 Hyperbaric Oxygen Therapy (HBO) National Government Services, Inc. (13282) New York – Upstate

L25204 Hyperbaric Oxygen Therapy (HBO) National Government Services, Inc. (13102) Connecticut

L25204 Hyperbaric Oxygen Therapy (HBO) National Government Services, Inc. (13202) New York – Entire State

L31579 Hyperbaric Oxygen Therapy (HBO) Palmetto GBA (11201) South Carolina

Jan 26, 2010 (Last Updated)

Medicare Administrative Contractors (MAC’s) and HBO Local Coverage Determinations (LCD’s)

It was a lot of hard work and digging but finally we have more than what we use to have as far as LCD’s are concerned. Below are the LCD’s from CMS’s MAC contractors by state (I tried per region but all it does is further confuse everyone – which is the way “they” want it to be).

ALABAMA
ALASKA
AMERICAN SAMOA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
DISTRICT OF COLUMBIA
FLORIDA 1
FLORIDA 2
GEORGIA 1
GEORGIA 2
GUAM
HAWAII
IDAHO
ILLINOIS
INDIANA 1
INDIANA 2
IOWA
KANSAS
KENTUCKY 1
KENTUCKY 2
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO 1
NEW MEXICO 2
NEW YORK 1
NEW YORK 2
NEW YORK (Upstate)
NEW YORK (Queens)
NORTH CAROLINA
NORTH DAKOTA
NORTHERN MARIANA ISLANDS
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
PUERTO RICO 1
PUERTO RICO 2
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGIN ISLANDS
VIRGINIA 1
VIRGINIA 2
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING

PLEASE REPORT BROKEN LINKS OR OUTDATED POLICIES (Updated Jan 26, 2010)

Medicare Administrative Contractors (MAC’s) Local Coverage Determinations (LCD’s)

BLUE CROSS/BLUE SHIELD
Missouri

CAHABA
Alabama
Georgia 1
Georgia 2

FIRST COAST
Florida 1
Florida 2
Puerto Rico 1
Puerto Rico 2
Virgin Islands

National Government Services (NGS)
Connecticut
Illinois
Indiana 1
Indiana 2
Kentucky 1
Kentucky 2
Massachusetts
Maine
Michigan
New York 1
New York 2
New York (Queens)
New York (Upstate)
Virginia
Wisconsin
West Virginia

NORIDIAN
Alaska
Arizona
Idaho
Minnesota
Montana
North Dakota
Oregon
Utah
Washington
Wyoming

PALMETTO GBA
American Samoa
California
Guam
Hawaii
Northern Mariana Islands
North Carolina
Nevada
South Carolina

PINNACLE
Arkansas
Louisiana
Mississippi

TRAILBLAZER
Colorado
New Mexico 1
New Mexico 2
Oklahoma
Texas
Virginia

WISCONSIN PHYSICIANS SERVICE (WPS)
Iowa
Kansas
Missouri
Nebraska

OTHER HBO MEDICAL POLICIES – PRIVATE INSURANCE, HMO’S ETC..
CIGNA HBO COVERAGE POLICY – 4/15/09 TO 4/15/2010
Anthem Blue Cross (California)
Blue Cross/Blue Shield (North Carolina)
Blue Cross/Blue Shield (Florida)
United Healthcare (Oxford Commercial Plan)
Wellmark Blue Cross and Blue Shield
Blue Sheild (California)
Blue Cross Blue Shield (Mississippi)
Blue Cross Blue Shield (Minnesota)
Blue Cross Blue Shield (Rhode Island)
Blue Cross Blue Shield (Massachusetts)
Blue Cross Blue Shield Regence (Oregon and Utah)
Blue Cross Blue Shield (Tennessee)
Aetna 2009 Hyperbaric Medical Policy
Presbyterian Health Plan
Priority Health (Michigan)
Harvard Pilgrim Health Care
LifeWise Health Plan of Oregon

3 thoughts on “HBO Policies & LCD’s

  1. Pingback: Medicare Contractor Hyperbaric Medical Policies Finally Posted Here!!! « Hyperbaric Tech Blog

  2. FYI:

    Highmark Medicare Services is the Part A Medicare Administrative Contractor for Delaware, New Jersey, Pennsylvania, Maryland, and the District of Columbia.

    Highmark Medicare Services is the Part B Medicare Administrative Contractor for Pennsylvania, Delaware, Maryland, New Jersey, and the District of Columbia Metropolitan Area. For Part B services, A/B MAC Jurisdiction12 includes the Counties of Arlington and Fairfax in Virginia and the City of Alexandria in Virginia. Services for the remainder of the state of Virginia will be covered under A/B MAC Jurisdiction 11.

    https://www.highmarkmedicareservices.com/

    Currently draft/on hold until further notice since the original effective date of 3/22/2011

    https://www.highmarkmedicareservices.com/policy/mac-ab/l31468.html

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