Greetings: Angela Brooks, the VPTA's Payer Relations Specialist,
requested that I send you the following time-sensitive announcement.
Thanks very much.
Debbie Kelly, Executive Director

Local Coverage Determination (LCD)
For Physical Medicine and Rehab Y-18AB

History:
Trailblazer Health is the intermediary for Medicare in the state of
Virginia. LCDs or local coverage determinations are utilization
management guidelines that Trailblazer uses to communicate billing
requirements and coverage standards for various medical procedures.
When a proposal is made to amend LCD language, it is posted to the
Trailblazer website and a period of time is allotted for
provider/member commentary via the website tools.

Current:
It was brought to my attention that Trailblazer has issued a
proposed LCD impacting Physical Medicine and Rehabilitation to
update the 7/5/2005 LCD. The current LCD (Y-13B-R7) and the
proposed LCD
(Y-18AB) can be found on www.Trailblazerhealth.com. The commentary
period began on 6/29/2005 and will end on 8/15/2005.

Based on the input that I have received, members are unhappy with
the current LCD and are confused and further frustrated by the new
proposed format.

The following list summarizes what appear to be the primary issues
of concern; issues that I urge members to comment to utilizing the
website or postal service (the mailing address is also supplied on
the website). Please note, this is only a summary, other individual
practitioners may note parameters that impact their unique practice
situations. If practitioners note that there are statements not
addressed here that would seemingly affect a number of providers,
please feel free to communicate these via the listserv, as well as
via the Trailblazer website.

Angela S. Brooks, PT
VPTA Payer Relations Specialist