Medicare Local Medical Review Policies – (LMRP’s)
LMRPs are policies with guidelines explaining how claims are paid by the Medicare Program. Each policy contains ICD-9-CM diagnosis codes, additions or deletions of diagnoses and replacement of procedure codes and/or descriptions. In the absence of national coverage policy, Medicare carriers determine regional coverage based on the advice and input of medical and specialty societies, and a review of current medical practice, clinical data and research studies. NHIC, our Medicare Part B carrier, has recently made several policy revisions. The Policies and web addresses where they can be found are as follows:
Cardiac Catheterization http://www.medicarenhic.com/lmrp/final/ne/CardiacCathR1.htm
Computerized Axial Tomography (CT) Scans; Head or Brain; Without and With Contrast Material(s) http://www.medicarenhic.com/lmrp/final/ne/02-R-6.htm
Echocardiography (Transthoracic, Transesophageal, and Doppler) http://www.medicarenhic.com/lmrp/final/ne/EchoR5.htm
Magnetic Resonance Angiography (MRA) http://www.medicarenhic.com/lmrp/final/ne/MRAR5.htm
Magnetic Resonance (E.G., Proton) Imaging Of The Brain http://www.medicarenhic.com/lmrp/final/ne/MRIbrainR3.htm
Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI) http://www.medicarenhic.com/lmrp/final/ne/ScanR1.htm
Group Psychotherapy
http://www.medicarenhic.com/lmrp/final/ne/GrpPsychR3.htm
Insight-Oriented, Behavior Modifying, and/or Supportive, Individual Psychotherapy href=http://www.medicarenhic.com/lmrp/final/ne/InPsychR3.htm
Interactive Individual Psychotherapy href=http://www.medicarenhic.com/lmrp/final/ne/InteractpsyR3.htm
Psychiatric Pharmacologic Management http://www.medicarenhic.com/lmrp/final/ne/PsychPharmR2.htm
Removal Of Skin Lesions http://www.medicarenhic.com/lmrp/final/ne/RemlesR7.htm
Shaving of Epidermal or Dermal Lesion http://www.medicarenhic.com/lmrp/final/ne/RemlesR7.htm
Thyroid Testing Including TSH http://www.medicarenhic.com/lmrp/final/ne/ThyR6.htm
Interferons (Alpha, Beta, Gamma)http://www.medicarenhic.com/lmrp/final/ne/InterferonR5.htm
All policies are available on the NHIC web site at http://www.medicarenhic.com/physician/ne/lmrp.htm Physicians are asked to read the policies that apply to their practice. Questions should be directed to Neil Walsh in the
Billing Compliance Department at 617-732-9377 or CWALSH6@partners.org