Interventions are performed on AV dialysis fistulas and grafts in order to restore adequate flow, to preserve the access' function, and avoid the need to create a new AV access. Indications for interventions on an AV dialysis access include compromised flow with threatened occlusion, recent thrombosis of AV dialysis access, and management of structural abnormalities such as pseudoaneurysms. These procedures encompass a number of percutaneous or open surgical procedures. Coverage GuidanceĬoverage Indications, Limitations, and/or Medical NecessityĪrteriovenous (AV) dialysis access (AV fistula, AV dialysis graft) interventions are intended to restore and/or maintain functional patency of the AV dialysis access. Section 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.ĬMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 11: End Stage Renal Disease (ESRD):Ģ0.1 Noninvasive Vascular Studies for End Stage Renal Disease (ESRD) PatientsĨ0 Physician’s Services for Renal Dialysis Patients - GeneralĬMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 14: Medical Devices:Ģ0 FDA Approval Investigational Device Exemptions (IDEs) 20.2 - Category BĬMS Publication 100-03, Medicare National Coverage Determinations Manual, Part 1:Ģ0.7.B1 Percutaneous Transluminal Angioplasty (PTA)20.7.D OtherĬMS Publication 100-09, Medicare Contactor Beneficiary and Provider Communications Manual, Chapter 5: Correct Coding Initiative.ĬMS Transmittal AB-00-44, Change Request #1118, May 2000: Medicare Coverage of Non-Invasive Vascular Studies When Used to Monitor the Access Site of End Stage Renal Disease (ESRD) Patients.ĬMS Transmittal AB-00-55, Change Request #1117, June 2000: Hemodialysis Flow Study. Section 1862(a)(1)(A) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member. Title XVIII of the Social Security Act (SSA): Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources: See Section 1869(f)(1)(A)(i) of the Social Security Act. In addition, an administrative law judge may not review an NCD. NCDs and coverage provisions in interpretive manuals are not subject to the Local Coverage Determination (LCD) Review Process (42 CFR 405.860 and 42 CFR 426 ). Language quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. Not endorsed by the AHA or any of its affiliates. Presented in the material do not necessarily represent the views of the AHA. Preparation of this material, or the analysis of information provided in the material. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness orĪccuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the Resale and/or to be used in any product or publication creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions Īnd/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is onlyĪuthorized with an express license from the American Hospital Association. Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816. AHA copyrighted materials including the UB‐04 codes andĭescriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may beĬopied without the express written consent of the AHA. All rights reserved.Ĭopyright © 2023, the American Hospital Association, Chicago, Illinois. The AMA assumes no liability for data contained or not contained herein.Ĭurrent Dental Terminology © 2022 American Dental Association. The AMA does not directly or indirectly practice medicine or dispense medical services. Applicable FARS/HHSARS apply.įee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not AMA CPT / ADA CDT / AHA NUBC Copyright StatementĬPT codes, descriptions and other data only are copyright 2022 American Medical Association.
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