Q. What language should be included in the appropriate liability notice (Advanced Beneficiary Notice of Noncoverage (ABN) and Hospital Issue Notice of Non-coverage (HINN)) to beneficiaries over 60 years of age who choose to have the Lumbar Artificial Disc Replacement (LADR) using the Charite lumbar artificial disc?

A. The following language should be included in the ABN:

• Under the “Items or Service” section: LADR with Charite Lumbar Artificial Disc.
• Under the “Because” section: After a national coverage analysis (NCA), Medicare issued a national coverage determination (NCD) (Section 150.10 of Medicare NCD Manual) that stated that LADR with the Charite Lumbar Artificial Disc is not reasonable and necessary for Medicare beneficiaries over 60 years of age. Therefore, LADR with the Charite lumbar artificial disc is non-covered for beneficiaries over 60 years of age. Medicare never pays for this service for this Medicare population.

Source: Center for Medicare & Medicaid Services
Reference: http://www.cms.hhs.gov/mlnmattersarticles/downloads/MM5057.pdf