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Thank you for your comments. Noridian respectfully disagrees with commenters and believes that evidence is sufficient to provide coverage for a therapeutic implantable continuous glucose monitor if coverage criteria is met. Although different in product design, the concept of an implantable sensor device is a reasonable and necessary option for Medicare beneficiaries as they work in partnership with their treating provider to achieve optimal control of their diabetes.

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For Technical and Application Information including Feed Speeds, HEM Slotting, Facing, Helical Ramping, Straight Line Ramps, Long Reach Adjustments, Eliminating Wall Taper When Finishing, Ball Node Endmill Adjustments, Surface Finishing.

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Dec 7, 2023 — Milling tools can be categorized into various types, including End Mill,Face Milling Cutter,Three-Edge End Mill,Keyway Milling Cutter,Saw ...

CPT codes, descriptions, and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Note: There are 2,350 postcode areas listed here and each covers 100 postcode areas, making around 235,000 postcode districts. globalpriority globalpriority.

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• Thread mills can adjust the tolerance of the thread• Thread mills can cut material in progressive passes which is better for hard materials• They won’t get stuck in parts if they break• They can cut different thread sizes with the same tool• They can cut odd sized threads• They can be used to back chamfer a hole• They require much less horsepower from your machine than tapping• Thread mills are available in carbide which most taps are not• Thread milling achieves a higher quality thread than tapping because chip removal is more efficient leading to a better result• Most types of thread taps require a hole bigger than the threads resulting in a weak thread. • Thread milling creates a thread with a smaller tolerance for a stronger thread

ISO Metric, American UN – Uses a 60° thread angle. These threads are used for general purposes.NPT – National Pipe Tapered is an internal tapered 60° thread used on pipes and fittings. The taper thread will pull tight and form a fluid-tight seal. This type of thread requires a sealant and is not suitable for high-pressure applications.NPS – National Pipe Standard has a 60° straight thread. NPTF – This is a 60° degree NPT thread that is used for high pressure or fuel applications.British Standard, Whitworth – Uses a 55° internal thread form and is often used when a watertight seal is needed.UNJ, MJ – Often used in the Aerospace industry and feature a radius at the root of the thread.

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Thank you for your comments. Noridian agrees that because there is another option for insulin therapy that comes in a non-injectable form, the verbiage will be changed to “insulin administrations” rather than “injections”.

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The Comment period for the Implantable Continuous Glucose Monitors (I-CGM) L38657 began on 05/21/2020 and ended on 07/06/2020.  Comments were received from the provider community. The notice period begins on 09/17/2020 and ends 11/01/2020. The LCD becomes final on 11/02/2020.

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NCDs do not contain claims processing information like diagnosis or procedure codes nor do they give instructions to the provider on how to bill Medicare for the service or item. For this supplementary claims processing information we rely on other CMS publications, namely Change Requests (CR) Transmittals and inclusions in the Medicare Fee-For-Service Claims Processing Manual (CPM).

We would like to see language added to the coverage criteria to account for patients who have adopted other CGM systems and may have had trouble complying, managing them, and cases when the CGM might not be appropriate anymore in light of other CGM options, like I-CGM.

These materials contain NUBC Official UB-04 Specifications (UB-04 Data), which is copyrighted by the American Hospital Association (AHA).

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Articles which directly support an LCD are known as “LCD Reference Articles”. The referenced LCD may be cited in the Article Text field and may also be linked to in the Related Documents field. Examples may include but are not limited to Response to Comments and some Billing and Coding Articles. If you have a question about this kind of article, please contact the MAC listed within the Contractor Information section of the article. Articles identified as “Not an LCD Reference Article” are articles that do not directly support a Local Coverage Determination (LCD). They do not include a citation of an LCD. An example would include, but is not limited to, the Self-Administered Drug (SAD) Exclusion List Articles. If you have a question about this kind of article, please contact the MAC listed within the Contractor Information section of the article. There are different article types: Billing and Coding articles provide guidance for the related Local Coverage Determination (LCD) and assist providers in submitting correct claims for payment. Billing and Coding articles typically include CPT/HCPCS procedure codes, ICD-10-CM diagnosis codes, as well as Bill Type, Revenue, and CPT/HCPCS Modifier codes. The code lists in the article help explain which services (procedures) the related LCD applies to, the diagnosis codes for which the service is covered, or for which the service is not considered reasonable and necessary and therefore not covered. Response to Comment (RTC) articles list issues raised by external stakeholders during the Proposed LCD comment period. Self-Administered Drug (SAD) Exclusion List articles list the CPT/HCPCS codes that are excluded from coverage under this category. The Medicare program provides limited benefits for outpatient prescription drugs. The program covers drugs that are furnished "incident-to" a physician's service provided that the drugs are not "usually self-administered" by the patient. CMS has defined "not usually self-administered" according to how the Medicare population as a whole uses the drug, not how an individual patient or physician may choose to use a particular drug. For purpose of this exclusion, "the term 'usually' means more than 50 percent of the time for all Medicare beneficiaries who use the drug. Therefore, if a drug is self-administered by more than 50 percent of Medicare beneficiaries, the drug is excluded from coverage" and the MAC will make no payment for the drug. Draft articles are articles written in support of a Proposed LCD. A Draft article will eventually be replaced by a Billing and Coding article once the Proposed LCD is released to a final LCD.

This page displays your requested Article. The document is broken into multiple sections. You can use the Contents side panel to help navigate the various sections. Articles are a type of document published by the Medicare Administrative Contractors (MACs). Articles often contain coding or other guidelines and may or may not be in support of a Local Coverage Determination (LCD).

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Too slow cutting speeds lead to edge build-up and blunting, while too fast results in quicker insert wear, deformation and poor finish. Tool feed calculator F.

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Since it is required that the implantable continuous glucose monitor sensor be replaced every 90 days, the criterion regarding the beneficiary requiring an in-person visit with the treating practitioner every 6 months is unnecessary and may add to confusion.

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Thread Mills achieve their thread cutting ability by a method called helical interpolation. Helical interpolation involves simultaneous circular X and Y axis movement combined with an axial (Z) feed and a defined pitch. The helical interpolation tool path makes thread mills versatile with the ability to cut right and left hand threads, internal and external threads, and produce a variety of thread sizes.

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We would also like to comment around this renewed look at how Category III CPT codes are being viewed by the Medicare Administrative Contractors as historically this has been a very difficult and potentially short-sighted process in developing access to new medical technologies. Given most new technology must first utilize a Category III CPT code to establish market uptake it has been difficult to deliver that market uptake in the face of non-coverage. The establishment of an LCD for I-CGM proves that newer innovation can be supported by clinical evidence such that the scientific community can agree on its impact on health outcomes, irrespective of its current coding status. We ask that the Contractors continue to evaluate new technology based on its current evidence and potential impact on health outcomes versus categorically denying their coverage merely because of the code that supports that technology.

Enter the CPT/HCPCS code in the MCD Search and select your state from the drop down. (You may have to accept the AMA License Agreement.) Look for a Billing and Coding Article in the results and open it. (Or, for DME MACs only, look for an LCD.) Review the article, in particular the Coding Information section.

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We also recommend modification of the wording related to insulin treatment to eliminate the word “injections.” There is an inhaled insulin on the market used by some patients. To accommodate that reality, the wording should reflect “multiple daily administrations” with insulin, not “injections.”

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Thank you for your comments. An exception statement will be added to the LCD allowing transition to an I-CGM in instances where a beneficiary has previously met coverage criteria for a non-implantable continuous glucose monitor and subsequently chooses to switch to an implantable device. This will require the treating provider’s cooperation and involvement as a small procedure is required to implant the I-CGM sensor.

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Articles are a type of document published by the Medicare Administrative Contractors (MACs). Articles often contain coding or other guidelines and may or may not be in support of a Local Coverage Determination (LCD).

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Consistent application of the Medicare coverage criteria is critical to ensure Medicare beneficiaries receive the most appropriate items and services to diagnose and treat their clinical conditions. At this time, we do not believe the published evidence related to Implantable CGMs supports a conclusion that Implantable CGMs are reasonable and necessary for use by diabetic Medicare beneficiaries.

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For the most part, codes are no longer included in the LCD (policy). You will find them in the Billing & Coding Articles. Try using the MCD Search to find what you're looking for. Enter the code you're looking for in the "Enter keyword, code, or document ID" box. The list of results will include documents which contain the code you entered.

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We ask that Noridian delay establishing Medicare coverage for Implantable CGMs until published evidence demonstrates the ability of Implantable CGMs to improve clinical outcomes in Medicare beneficiaries with diabetes on insulin therapy. The differences in patient adherence, product design, and use between Implantable and external sensor CGM devices weigh against Noridian adopting this Draft LCD that concludes Implantable CGMs will confer clinical benefits on Medicare patients.

Thread milling first appeared about 25 years ago in response to NASA’s need to machine high-quality threaded holes in difficult materials such as Titanium, Hastelloy and Inconel. Thread milling has become a more cost effective method to process and produce threads in hardened materials up to 70 Rockwell, than by the older method of using taps. Thread milling has many advantages of thread making over tapping.

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We urge that you change the blood glucose self-testing requirement for I-CGMs to at least three (3) times per day, consistent with Medicare coverage policy for test strips and current scientific understanding and clinical recommendations from the experts in diabetes care. While it is possible to secure coverage for four or more test strips per day, it involves more paperwork and administrative hurdles for patients, providers and DME suppliers.

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Articles identified as “Not an LCD Reference Article” are articles that do not directly support a Local Coverage Determination (LCD). They do not include a citation of an LCD. An example would include, but is not limited to, the Self-Administered Drug (SAD) Exclusion List Articles. If you have a question about this kind of article, please contact the MAC listed within the Contractor Information section of the article.

Thank you for your comments. Noridian agrees that this requirement may appear redundant. Therefore, this requirement will be removed from the LCD.

Please Note: For Durable Medical Equipment (DME) MACs only, CPT/HCPCS codes remain located in LCDs. All other Codes (ICD-10, Bill Type, and Revenue) have moved to Articles for DME MACs, as they have for the other Local Coverage MAC types.

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