Article Detail - JA DME

Joint DME MAC Publication

Outlined below are the principal changes to the DME MAC Local Coverage Determination (LCD) and Policy Articles (PAs) that have been revised and posted. The policies included are Lower Limb Prostheses and Power Mobility Devices. Please review the entire LCDs and related PAs for complete information.

Lower Limb Prostheses

LCD

Revision Effective Date: 01/01/2024
HCPCS CODES:
Added: HCPCS codes L5615 and L5926

12/28/2023: 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: 01/01/2024
CODING GUIDELINES:
Added: HCPCS code L5926 coding guideline information

12/28/2023: At this time 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.

Power Mobility Devices

PA

Revision Effective Date: 05/16/2023
CODING GUIDELINES:
Revised: No Power Options definition, from "A category of PWCs that is incapable of accommodating a power tilt, recline, seat elevation, or standing system. If a PWC can only accept power elevating legrests, it is considered to be a No Power Option chair." to "No Power Options – A category of PWCs that is incapable of accommodating a power tilt, recline, or standing system. If a PWC can only accept power elevating legrests and/or seat elevation, it is considered to be a No Power Option chair."
Revised: Group 2 no power option PWC information, by removing "seat elevation" from the options the PWC is incapable of accommodating
Revised: Group 3 and 4 no power option PWC information, by removing "seat elevation" from the options the PWC is incapable of accommodating

12/28/2023: At this time 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.