Contractor Name
HealthNow UMD

Contract Number
00801

Contractor Type
Carrier

LCD Database ID Number
L3748

LCD Title
Botulinum Toxin Type A and Type B

Contractor's Determination Number
DR010E05 End dated

AMA CPT Copyright Statement
CPT codes, descriptions and other data only are copyright 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS clauses apply. Current Dental Terminology (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. (C) 2002 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

CMS National Coverage Policy

   -   Title XVIII of the Social Security Act, Section 1862 (a)(7)

       This section excludes routine physical examinations.

   -   Title XVIII of the Social Security Act, Section 1862 (a)(1)(A)

       This section allows coverage and payment for only those services
       considered medically reasonable and necessary.

   -   Title XVIII of the Social Security Act, Section 1833 (e)

       This section prohibits Medicare payment for any claim which lacks the
       necessary information to process the claim.

   -   CMS Manual System, Publication 100-2, Medicare Claims Processing,
       Chapter 16, Section 120

       This section concerns the non coverage for cosmetic procedures.

       (CPT code 64653 is a non-covered service since it is considered
       cosmetic)

   -   CMS Manual System, Publication 100-4, Medicare Claims Processing
       Manual, Chapter 17, section 40

       This section concerns discarded drugs and biologicals

Oversight Region
Region II

CMS Consortium
Northeast

Original Determination Effective Date
For services performed on or after 03/01/2001

Original Determination Ending Date
XXXXXXX

Revision Effective Date
02/22/2007

Revision Ending Date
07/30/2008

Indications and Limitations of Coverage and/or Medical Necessity
Botulinum Toxin Type A and Botulinum Toxin Type B injections are used to treat various focal muscle spastic disorders and excessive muscle contractions such as dystonias, spasms, twitches, etc. The resulting chemical-denervation of muscle produces temporary local paresis or paralysis and allows individual muscles to be weakened selectively

   1.  Botulinum Toxin Type A has been tested or adopted for therapeutic use
       in four clinical areas: ophthalmology (for treating blepharospasm and
       strabismus); neurology (primarily for treating focal dystonias but
       also for treating some segmental dysphonias); otolaryngology (for
       treating spasmodic dysphonia); and areas of general medicine, such as
       gastroenterology, that focus on smooth muscle and sphincter control
       (for treating achalasia). In recent years, the literature has
       supported the use of Botulinum Toxin Type B for the general
       applications for which Type A is accepted.

   2.  Botulinum Toxin Type A and Type B can be used to reduce spasticity or
       excessive muscular contractions to relieve pain; to assist in
       posturing and walking; to allow better range of motion; to permit
       better physical therapy; to reduce severe spasm in order to provide
       adequate perineal hygiene.

   3.  In July 2004, the FDA granted approval to botulinum toxin type A
       (BOTOX(R)) (but not Type B) for the treatment of severe primary
       axillary hyperhidrosis that is inadequately managed with topical
       agents. The definition and diagnosis of Primary Focal Hyperhidrosis
       is:

       -    Severe Sweating, beyond physiological needs.

       -    Focal, visible, severe sweating of at least 6 months duration
            without apparent cause with at least 2 of the following
            characteristics.

       -    Bilateral and relatively symmetric.

       -    Significant impairment in daily activities

       -    Age of onset less than 25 years

       -    Positive family history

       -    Cessation of focal sweating during sleep

   4.  The treatment of sialorrhea due to conditions such as motor neuron
       disease or Parkinson'sdisease in those patients who have failed to
       respond to a reasonable trial of traditional therapies (i.e.,
       anticholinergics, speech therapy, surgical therapy) or who have a
       contraindication to traditional therapy will be considered for
       coverage. Determination regarding whether botulinum toxin type A or
       type B is the most appropriate course of treatment should be based on
       the physician's judgment, clinical experience, and the patient's
       individual history.

   5.  Coverage of Botulinum Toxin Type A and Type B for certain spastic
       conditions (e.g., cerebral palsy, stroke, head trauma, spinal cord
       injuries, and multiple sclerosis), will be limited to those conditions
       listed in the "ICD-9 CM Codes that Support Medical Necessity" section.
       All other uses in the treatment of other types of spasm, including
       smooth muscle types, will be considered investigational and therefore,
       noncovered by Medicare.

   6.  Reimbursement for the injection code will be for a single unit of
       service, operative session, regardless of the number of injections
       performed unless the procedure is bilateral or more than one body
       region is injected.

   7.  The patient who has a spastic or excessive muscular contraction
       condition is usually started with a low dose of Botulinum Toxin Type A
       (10 units) and the accepted maximum dosage per site is about 50-100
       units.  Other spastic or muscular contraction conditions, such as, eye
       muscle disorders, e.g., blepharospasm, may require lesser amounts such
       as only 3-5 units.  For larger muscle groups, it is generally agreed
       that once a maximum of 25 units per site has been reached and there is
       no response, the treatment is discontinued.  The treatments may be
       resumed at a later date, if clinically appropriate.  With response,
       the effect of the injections generally lasts for three (3) months, at
       which time, the patient may need repeat injections to control the
       spastic or excessive muscular condition.

   8.  Coverage of treatments provided may be continued unless any two
       treatments in a row, utilizing an appropriate or maximum dose of
       Botulinum Toxin Type A and Type B, failed to produce a satisfactory
       clinical response.  Providers must also document in the patient's
       medical record, the results of and the response to these injections
       after each session, and the medical record must be available to the
       carrier upon request.

   9.  If the upper and lower lid of the same eye and/or adjacent facial
       muscles or brow are injected with Botulinum toxin type A or Type B at
       the same surgery, the procedure is considered to be unilateral.
       Bilateral procedures will only be considered when both eyes or both
       sides of the face are injected.

   10. Botulinum Toxin Type A can be used to treat urinary incontinence due
       to neurogenic bladder. This treatment will be reimbursed if used only
       after documented failure of medical therapy.

   11. Claims submitted for the following conditions:  migraine headaches,
       myofascial pain, irritable colon, biliary dyskinesia, and any
       treatment of other spastic conditions not listed in the "ICD-9-CM
       Codes That Support Medical Necessity" section will be considered to be
       investigational, (including the treatment of smooth muscle spasm), not
       safe and effective, or not accepted as the standard of practice within
       the medical community and, therefore, not medically reasonable and
       necessary.

   12. Treatment of wrinkles (ICD-9-CM code 701.8) using Botulinum Toxin Type
       A or Type B is considered to be cosmetic and is not covered under
       Medicare.

   13. The cost of special syringes is not separately payable.  They are
       considered part of the surgical procedure.

Coding information

Bill Type Codes:
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

Revenue Codes:
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

    99999           Not Applicable

CPT/HCPCS Codes
The terminology for CPT code 31571 has been revised effective 01/01/2006.
CPT codes 46505, 64613, 64650 and 64653 have been added effective 01/01/2006.
NOTE: CPT code 64653 is a non-covered service since it is considered cosmetic.
NOTE: CPT code 53899 should be used for the bladder injection.
NOTE: CPT code 42699 should be used for injection of salivary glands or ducts for sialorrhea.

    J0585          Botulinum toxin type A, per unit

    J0587          Botulinum toxin type B, per 100 units

    31513          Laryngoscopy, indirect; with vocal cord injection

    31570          Laryngoscopy, direct, with injection into vocal
                   cord(s), therapeutic;

    31571          ; with operating microscope or telescope

    42699          Unlisted procedure, salivary glands or ducts

    43200          Esophagoscopy, rigid or flexible, diagnostic with of
                   without collection of specimen(s) by brushing or
                   washing (separate procedure)

    43201          Esophagoscopy, rigid or flexible; with directed
                   submucosal injection(s), any substance

    46505          Chemodenervation of internal anal sphincter

    53899          Unlisted procedure, urinary procedure

    64612          Chemodenervation of muscles; muscle(s) innervated by
                   facial nerve (eg, for blepharospasm, hemifacial
                   spasm);

    64613          ; neck muscle(s) (e.g., for spasmodic torticollis,
                   spasmodic dysphonia)

    64614          ; extremity(s) and/or trunk muscle(s) (eg, for
                   dystonia, cerebral palsy, multiple sclerosis

    64640          Destruction by neurolytic agent, paravertebral facet
                   joint nerve; other peripheral nerve or branch

    64650          Chemodenervation of eccrine glands; both axillae;

    64653          ; other area(s) (eg,scalp, face, neck), per day

    67345          Chemodenervation of extraocular muscle

Does the CPT 30% Coding Rule Apply?
No

ICD-9-CM Codes That Support Medical Necessity
TRUNCATED DIAGNOSIS CODES ARE NOT ACCEPTABLE.

ICD-9-CM code listings may cover a range and include truncated codes. It is the provider's responsibility to avoid truncated codes by selecting a code(s) carried out to the highest level of specificity and selected from the ICD-9-CM book appropriate to the year in which the service was performed.

It is not enough to link the procedure code to a correct, payable ICD-9-CM code. The diagnosis or clinical signs/symptoms must be present for the procedure to be paid. Further, these ICD-9-CM codes can be used only with the conditions listed in the "Indications" and "Limitations" section of this LCD.

*ICD-9-CM code is payable only for HCPCS code J0585.

*ICD-9-CM codes 596.54, 788.31, 788.33 and 788.34 have been added as payable only for HCPCS code J0585 effective for dates of service 06/09/2006.

*ICD-9-CM code 527.7 is to be reported for patients with sialorrhea

*ICD-9-CM codes 333.71, 333.79 and 341.22 have been added effective for dates of service on or after 10/01/2006

ICD-9CM codes 344.00-344.09, 344.1, 344.2, 344.30-344.32 and 344.40 are to be used only when there is spasticity of central nervous system origin.

    333.6           Idiopathic torsion dystonia

    333.7           Symptomatic torsion dystonia (Truncated as of
                    10/01/2006)

    333.71*         Athetoid cerebral palsy

    333.79*         Other acquired torsion dystonia

    333.81          Blepharospasm

    333.82          Orofacial dyskinesia

    333.83          Spasmodic torticollis

    333.84          Organic writers' cramp

    333.89          Fragments of torsion dystonia, other

    334.1           Hereditary spastic paraplegia

    340             Multiple sclerosis

    341.0           Neuromyelitis optica

    341.1           Schilder's disease

    341.22*         Idiopathic transverse myelitis

    341.8           Other demyelinating diseases of central nervous
                    system

    341.9           Demyelinating disease of central nervous system,
                    unspecified

    342.11          Spastic hemiplegia, affecting dominant side

    342.12          Spastic hemiplegia, affecting nondominant side

    343.0           Infantile cerebral palsy, diplegic

    343.1           Infantile cerebral palsy, hemiplegic

    343.2           Infantile cerebral palsy, quadriplegic

    343.3           Infantile cerebral palsy, monoplegic

    343.4           Infantile cerebral palsy, infantile hemiplegia

    343.8           Other specified infantile cerebral palsy

    343.9           Infantile cerebral palsy, unspecified

    344.00-344.09   Quadreplegia unspecified - other quadriplegia

    344.1           Paraplegia

    344.2           Diplegia of upper limbs

    344.30-344.32   Monoplegia of lower limb affecting unspecified side
                    - Monoplegia of lower limb affecting nondominant
                    side

    344.40-344.42   Monoplegia of upper limb affecting unspecified side
                    - Monoplegia of upper limb affecting nondominant
                    side

    351.8           Other facial nerve disorders

    378.00          Esotropia, unspecified

    378.01          Monocular esotropia

    378.02          Monocular esotropia with A pattern

    378.03          Monocular esotropia with V pattern

    378.04          Monocular esotropia with other noncomitancies

    378.05          Alternating esotropia

    378.06          Alternating esotropia with A pattern

    378.07          Alternating esotropia with V pattern

    378.08          Alternating esotropia with other noncomitancies

    378.10          Exotropia, unspecified

    378.11          Monocular exotropia

    378.12          Monocular exotropia with A pattern

    378.13          Monocular xxotropia with V pattern

    378.14          Monocular exotropia with other noncomitancies

    378.15          Alternating exotropia

    378.16          Alternating exotropia with A pattern

    378.17          Alternating exotropia with V pattern

    378.18          Alternating exotropia with other noncomitancies

    378.20          Intermittent heterotropia, unspecified

    378.21          Intermittent esotropia, monocular

    378.22          Intermittent esotropia, alternating

    378.23          Intermittent exotropia, monocular

    378.24          Intermittent exotropia, alternating

    378.30          Heterotropia, unspecified

    378.31          Hypertropia

    378.32          Hypotropia

    378.33          Cyclotropia

    378.34          Monofixation sydrome

    378.35          Accomodative component in esotropia

    378.40          Heterophoria, unspecified

    378.41          Esophoria

    378.42          Exophoria

    378.43          Vertical heterophoria

    378.44          Cyclophoria

    378.45          Alternating hyperphoria

    378.50          Paralytic strabismus, unspecified

    378.51          Third or oculomotor nerve palsy, partial

    378.52          Third or oculomotor nerve palsy, total

    378.53          Fourth or trochlear nerve palsy

    378.54          Sixth or abducens nerve palsy

    378.55          External ophthalmoplegia

    378.56          Total ophthalmoplegia

    378.60          Mechanical strabismus, unspecified

    378.61          Brown's (tendon) sheath syndrome

    378.62          Mechanical strabismus from other musculofasical
                    disorders

    378.63          Limited function associated with other conditions

    378.71          Duane's syndrome

    378.72          Progressive external ophthalmoplegia

    378.73          Strabismus in other neuromuscular disorders

    378.81          Palsy of conjugate gaze

    378.82          Spasm of conjugate gaze

    378.83          Convergence insufficiency or palsy

    378.84          Convergence excess or spasm

    378.85          Anomalies of divergence

    378.86          Internuclear ophthalmoplegia

    378.87          Other dissociated deviation of eye movements

    378.9           Unspecified disorder of eye movements

    478.75          Laryngeal spasm

    527.7*          Disturbance of salivary secretion

    530.0           Achalasia and cardiospasm

    564.6           Anal spasm

    565.0           Anal fissure

    596.54*         Neurogenic bladder NOS

    705.21*         Primary focal hyperhidrosis

    723.5           Torticollis, unspecified

    728.85          Spasm of muscle

    788.31*         Urge incontinence

    788.33*         Mixed incontinence (male) (female)

    788.34*         Incontinence without sensory awareness

ICD-9-CM Codes That DO NOT Support Medical Necessity:
Use of any ICD-9-CM code not listed in the "ICD-9-CM Codes That Support Medical Necessity" section of this LCD will be denied

Documentation Requirements

   1.  Each claim must be submitted with ICD-9-CM codes that reflect the
       condition of the patient, and indicate the reason(s) for which the
       service was performed.  Claims submitted without ICD-9-CM codes will
       be returned.

   2.  Documentation should include the following elements, and be available
       to the carrier upon request:

       -    support for the medical necessity of the Botulinum Toxin Type A
            or Type B injections

       -    dosage and frequency of the injections

       -    support for the medical necessity of electromyography procedures

       -    support of the clinical effectiveness of the injections

       -    specify the site(s) injected.

   3.  Due to the short life span, after reconstitution, Medicare will
       reimburse the unused portion of Botulinum Toxin Type A or Type B only
       when the vial is not split between patients.  However, documentation
       must show in the patient's medical record the exact dosage of the drug
       given and the exact amount of the discarded portion of the drug.

   4.  Documentation must be available to Medicare upon request.

   1.  It is generally not considered medically necessary to give Botulinum
       Toxin Type A and Type B injections for spastic or excess muscular
       contraction conditions more frequently than every 90 days.

   2.  For the treatment of blepharospasm, strabismus and cranial VII nerve
       disorders, reimbursement of Botulinum Toxin would not be expected to
       exceed 200 units per patient per treatment cycle or or 90 days.

   3.  For the treatment of spasmodic torticollis, reimbursement of Botulinum
       Toxin would not be expected to exceed 300 units per patient per
       treatment cycle or 90 days.

   4.  Claims exceeding these frequencies will be denied as not reasonable
       and necessary.

   1.  Copyright Medicode's HCPCS 2002

   2.  Copyright 2002, Physicians' Current Procedural Terminology, American
       Medical Association

   3.  Template Policy (Revised June 11, 1996)

   4.  Empire Medicare Services-New York (Policy Number YSRG #01 Revision #2
       dated January 28, 2000)

   5.  Other Carrier Policy (Pennsylvania Policy Number I-16 effective August
       2, 1998)

   6.  A Comparison of Botulinum Toxin and Saline for the Treatment of
       Chronic Anal Fissure; G. Maria, M.D., E. Cassetts, M.D., D. Gui, M.D.,
       G. Brisinda, M.D., A. Bentivoglia, M.D., A. Albanese, M.D., The New
       England Journal of Medicine Vol. 338, No. 4 January 22, 1998

   7.  Treatment of Achalasia in Chagas' Disease with Botulinum Toxin; A.
       Ferrari, Jr.,M.D., E Siqueira, M.D.; The New England Journal of
       Medicine Vol. 332, No. 12, March 23, 1995

   8.  Botulinum Toxin: A Deadly Poison Sheds Its Negative Image; Annals of
       Internal Medicine, October 1, 1996. 125:616-617

   9.  British Journal of Dermatology (C) 2002 147:1218-1226

   10. Arezzo AC, Litwak MS, Meyer KE, Shopp, GM, "The Duration of Paralysis
       in the Trapezius Muscle Induced by Botulinum Toxins in the Cynomolgus
       Monkey" Archives of Pharmacology 2002;June 365(supp2).

   11. Leslie Baumann, MD, Monica L. Halem, MD "Botulinum Toxin-B and the
       Management of Hyperhidrosis." Clinics in Dermatology 2004;22:60-65

   12. Argoff Charles E, MD "The Use of Botulinum Toxins for Chronic Pain and
       Headaches. Current Treatment Options in Neurology 2003 5:483-492.

   13. Gwynn, Matthews W.MD, English, Jeffrey MD Baker Tisha,
       CRC."Double-Blind, Placebo-Controlled study of Myobloc(R)(Botlinum
       toxin Type B) for preventing chronic headache"

   14. Ondo, William G, MD, Hunter, Christine, RN, Moore, Warren, MD "A
       double blind placebo controlled trial of botulinum toxin B for
       sialorrhea in Parkinson's disease" Neurology 2004; 62; 37-40

   15. Brigitte Schurch et al, Botulinum Toxin Type A is Safe and Effective
       Treatment for Neurogenic Urinary Incontinence: Results of a Single
       Treatment, Randomized, Placebo Controlled 6-Month Study. The JNL of
       Urology, 174:196-200, 2005

   16. Antonella Giannantoni, et al , Intravesical Resiniferatoxin versus
       Botulinum - A Toxin Injections for Neurogenic Detrusor Overactivity: A
       Prospective Randomized Study. The JNL of Urology, 172: 240-243, 2004

   17. Sahai A, et al, Botulinim Toxin-A For Patients with Idiopathic
       Detrusor Overactivity: Early Results from a Randomized, Double-Blind,
       Placebo-Controlled Trial.

   18. From the Department of Urology, Guy's and St. Thomas' NHS & GKT School
       of Medicine.

   19. Christopher P Smith and Michael B Chancellor, Emerging Role of
       Botulinum Toxin in the Management of Voiding Dysfunction. The JNL of
       Urology 171: 2128-2137, 2004

   20. Turk-Gonzales Melissa, Odderson Ib R. Quantitative Reduction of Salvia
       Production with Botulinum Toxin Type B Injection into the Salivary
       Glands. Neurorehabilitation and Neural Repair 19(1):2005: 58-61

   21. Jongerius, Peter H. MD, van den Hoogen, J.A., MD, PhD,van Limbeek,
       Jacques, MD, PhD, Gabre?s, Fons J. MD, PhD, van Hulst, Karen, BSc, and
       Rotteveel, Jan J., MD, PhD. Effect of Botulinum Toxin in the Treatment
       of Drooling: A Controlled Clinical Trial. Pediatrics Vol. 114 No. 3
       September 2004: 620-627.

   22. Naumann, Markus, MD and Jost, Wolfgang, MD. Botulinum Toxin Treatment
       of Secretory Disorders. Movement Disorders, Vol. 19, Suppl. 8, 2004:
       S137-S141.

   23. Glickman, S. and Deaney, C. N. Treatment of relative sialorrhoea with
       botulinum toxin type A: description and rationale for an injection
       procedure with case report. European Journal of Neurology 2001, 8:
       567-571.

   24. Giess, R., Naumann, M., Werner, E., Riemann, R., Beck, M., Puls, I.,
       Reiners, C. and Toyka, K. V. Injections of botulinum toxin A into the
       salivary glands improve sialorrhoea in amyotrophic lateral sclerosis.
       Neurol Neurosurg Phychiatry, 2000; 69: 121-123.

   25. Dogu, Okan, Apaydin, Demir, Sevim, Serhan, Talas, Derya Umit and Arah,
       Mihriban. Untrasound-guided versis 'blind' intraparotid injections of
       botulinum toxin-A for the treatment of sialorrhoea in patients with
       Parkinson's disease. Clinical Neurology and Neurosurgery, 2004; 106,
       93-96.

   26. Baumann L Slezinger A, Halem M et al. Pilot study of the safety and
       efficacy of Myobloc (butulinum toxin type B) for treatment of axillary
       hyperhidrosis. Int J Dermatol 2005 May; 44(5):418-24.

   27. Baumann L, Halem ML. Systemic adverse effects after botulinum type
       B(Myobloc) injections for the treatment of palmar hyperhidrosis. Arch
       Dermatol 2003 February: 139(2):226-7.

   28. Baumann L, Slezinger A, Halem M et al. Double-blind, randominzed,
       placebo-controlled pilot study of the safety and efficacy of
       myobloc(botulinum toxin type B) for the treatment of palmar
       hyperhidrosis. Dermatol surg 2005 March; 31(3):263-70.

   29. Bauman L, Halem M Botulinum toxin-B and the management of
       hyperhidrosis. Clinics ad Dermatology. 2004:22-60.

   30. Dressler D, Saberi, FA, Benecke R. Botulinum toxin type B for
       treatment of axillary hyperhidrosis. 2 J Neurol. (2002) 249:1729-1732.

   31. Nelson, L Bachoo P, Holmes. Botulinum toxin type B: a new therapy for
       axillary hyperhidrosis. Br J Plast Surg 2005 March; 58(2):228-32.

   32. Hecht MJ, Birklein F, Winterholler M. Successfull treatment of
       axillary hyperhidrosis with very low doses of botulinum toxin B: A
       pilot study. Arch Dermatol Res 2004 February; 295(8-9):318-9.

   -   This LCD was returned to the Carrier Advisory Committee on October 13,
       2004.

   -   This LCD was originally presented at the September 13, 2000, Carrier
       Advisory Committee meeting by Empire Medicare Services New York.  It
       was subsequently adopted by the Upstate Medicare Division as part of
       the New York State coordination of policies.

   -   This LCD does not reflect the sole opinion of the contractor or
       Contractor Medical Director.  Although the final decision rests with
       the carrier, this LCD was developed in cooperation with advisory
       groups, which includes representatives from the Medical Society of the
       State of New York and the New York State Ophthalmological Society.

End Date of Comment Period
12/11/2004

Start Date of Notice Period
05/25/2007

Revision History Number
5

Revision History Explanation
This LCD is end dated because it is replaced with new policy "Botulinum Toxins Type A and Type B that went to the CAC for review on 1/17/08.

Revision #5: Removed double asterisk designation from the ICD-9CM section.

Added the following ICD-9CM codes as payable or revised the descriptions: 333.71, 333.79, 341.22, 344.00 - 344.09, 344.30 - 344.32, 344.40 - 344.42, 527.7, 596.54, 788.31, 788.33, 788.34. Added new sources #'s 15-32. Added new indications #4's and 10.

Revision #4: Revised HCPCS/CPT code section to reflect new/revised codes for the annual HCPCS update for 2006. Updated CMS National Coverage Policy Section

Correction: This correction updates the CAC information under the "Advisory Committee Meeting Notes" section, the Start Date of Comment Period, and the End Date of Comment Period. Also added Coverage Topic.

Revision #3: This version of the LCD will have a 45-day notice period. However, the revision effective date will be retroactive to July 29, 2005, to remain in coordination with Empire New York and New Jersey. (1)LCD and coding guideline article was presented as coordinated policy for NY and NJ at CAC. (2)Utilization guideline section clarified. (3) Revised ICD-9CM section for J0585 to match ICD-9-CM's for J0587, excluding 705.21. (4) ICD-9-CM 705.21 was added as a payable ICD-9-CM for J0585. (5) Indications and Limitations section revised to include information regarding Primary Axillary Hyperhidrosis. (6)Updated Sources of Information.

Revision #2: (1) Converted to a LCD. (2) Revised "Indications and Limitations" section. (3) Added "Indications and Limitations" #9 and #10. (4) Removed noncovered ICD-9-CM code 701.8. (5) Removed noncovered ICD-9-CM section (6) Added place of service (49) as payable. (7) Removed references to J3490.

Does this LCD contain a "Least Costly Alternative" provision?
No