Article Detail - JA DME

Outlined below are the principal changes to the DME MAC Local Coverage Determination (LCD) and Policy Article (PA) that have been revised and posted. The policy included is Urological Supplies. Please review the entire LCD and related PA for complete information.

Urological Supplies

LCD

Revision Effective Date: 04/01/2023
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Revised: Reference to inFlow device to include HCPCS code A4341
SUMMARY OF EVIDENCE:
Removed: Summary of evidence information, due to not being applicable to the non-discretionary changes
ANALYSIS OF EVIDENCE (RATIONALE FOR DETERMINATION):
Removed: Analysis of evidence information, due to not being applicable to the non-discretionary changes
HCPCS CODES:
Added: HCPCS codes A4341 and A4342
BIBLIOGRAPHY:
Removed: Bibliography information, due to not being applicable to the non-discretionary changes

04/27/2023: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates per CMS HCPCS coding determinations.

PA

Revision Effective Date: 04/01/2023
CODING GUIDELINES:
Revised: Billing direction for inFlow under HCPCS code A4335 for DOS April 1, 2021 through March 31, 2023
Added: Billing direction for inFlow under HCPCS A4341 and A4342 for DOS on or after 04/01/2023
Revised: Billing direction for Initial sizing and insertion to be billed to the Part B MAC
Added: Billing direction for replacement: "If a replacement of the indwelling intraurethral drainage device with valve is performed by the treating practitioner, claims for this service must be billed to the Part B MAC."
Revised: Billing direction for activator and charging base to be billed only as replacement using HCPCS code A4342

04/27/2023: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Note: The information contained in this article is only a summary of revisions to the LCDs and/or PAs. For complete information on any topic, you must review the LCDs and/or PAs.

With the update(s) listed above, Noridian would like to remind users how to find the policy that was previously effective. When billing, the supplier should follow guidance that was effective on the date of service. The below steps can be followed to find all previous policies:

1. Open the currently effective policy on the Medical Coverage Database (MCD)
   1. Links to the MCD can be found on the Active LCDs page on the Noridian website
      1. There is a link at the top of the Active LCD page that goes to a full list of the LCDs or PAs, depending on which link is selected OR
      2. There are direct links to all LCDs under the 'LCD ID number and Effective Date' column
2. Scroll down to the bottom of the policy
3. Find the section labeled Public Version(s)
4. Look for the link to the policy that was effective on the dates of service in question
5. Click on hyperlink to go to the policy