About this policy
The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Wireless Gastrointestinal Motility Monitoring Systems L33455.
Documentation requirements
Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.
CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 23, §10.1 general rules for diagnosis codes.
CMS Internet-Only Manual, Publication 100-08, Medicare Program Integrity Manual, Chapter 3, §3.4.1.3 diagnosis code requirements.
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
| Code | Code system | Status in this policy |
|---|---|---|
| 91112 | HCPCS | Covered |
| K31.84 | ICD10CM | Covered |
| K31.9 | ICD10CM | Covered |
| K58.1 | ICD10CM | Covered |
| K58.2 | ICD10CM | Covered |
| K58.8 | ICD10CM | Covered |
| K59.01 | ICD10CM | Covered |
| K59.03 | ICD10CM | Covered |
| K59.04 | ICD10CM | Covered |
| K59.2 | ICD10CM | Covered |
| R11.10 | ICD10CM | Covered |