Medical Director Articles - 2021

 
Title Brief Description Last Updated
HCPCS Code Pricing Correction - Dynamic Positioning Hardware (E2398) This article announces corrected pricing for HCPCS code E2398. 12/20/21
2022 HCPCS Code Update - January Edition - Correct Coding This article identifies changes to Level II Healthcare Common Procedure Coding System (HCPCS) codes for January 2022 12/16/21
Partial Foot, Shoe Insert (Toe Fillers), and Shoe Inserts for Diabetics - Coding Based on Benefit Category - Correct Coding This article provides correct coding for partial foot shoe inserts and shoe inserts for diabetics. Questions have arisen regarding beneficiaries who need accommodation for missing digits (toes). 12/16/21
RETIRED - Enteral Nutrition - Correct Coding and Billing - Revised Revised coding and billing instructions for enteral services effective for claims with dates of service on or after November 12, 2020, through claims with dates of service on or before September 4, 2021. 12/16/21
RETIRED - Parenteral Nutrition - Correct Coding and Billing - Revised Revised coding and billing instructions for parenteral services effective for claims with dates of service on or after November 12, 2020, through claims with dates of service on or before September 4, 2021. 12/16/21
Correct Coding of Finger, Hand, Hand-Finger and Wrist-Hand- Finger Braces (Orthoses) - Revised This article is a revised reminder to DMEPOS suppliers about the correct coding of finger, hand, hand-finger, and wrist-hand-finger braces. 11/18/21
RETIRED - Correct Coding of Elbow, Shoulder, Shoulder-Elbow-Wrist-Hand and Shoulder- Elbow-Wrist-Hand-Finger Braces (Orthoses) This article provides correct coding instructions for Elbow, Shoulder, Shoulder-Elbow-Wrist-Hand and Shoulder- Elbow-Wrist-Hand-Finger Braces 11/18/21
Articulating Digit(s) and Prosthetic Hands - Correct Coding - Revised This article is revised correct coding instructions for articulating digit(s) and prosthetic hands. 11/16/21
RETIRED - Correct Coding, Billing and Code Verification of HCPCS Code E0467 (Multi-Functional Ventilator) This article provides correct coding instructions for the multi-function ventilator (E0467). 11/11/21
Oxygen and Oxygen Equipment Local Coverage Determination (LCD) L33797 and Related Policy Article (PA) A52514 Update The DME MAC are in the process of revising the Oxygen and Oxygen Equipment LCD and the related Policy Article to reflect the national CMS policy changes to NCD 240.2 and the removal of NCD 240.2.2 10/28/21
RETIRED - Correct Coding of Finger, Hand, Hand-Finger and Wrist-Hand- Finger Braces (Orthoses) This article is a reminder to DMEPOS suppliers about the correct coding of finger, hand, hand-finger, and wrist-hand-finger braces. 10/28/21
Medicare Coverage for Shoes - Correct Coding - Revised This revised article provides statutory coverage for orthopedic shoes and therapeutic shoes for persons with diabetes 10/27/21
Open Meeting Agenda - Nebulizers Proposed Local Coverage Determination (LCD) This article provides the agenda for the Nebulizers Proposed LCD open meeting scheduled for November 3,2021 10/20/21
Open Meeting Agenda - Pneumatic Compression Devices Proposed Local Coverage Determination (LCD) This article provides the agenda for the Pneumatic Compression Devices Proposed LCD open meeting scheduled for November 3,2021 10/20/21
2021 HCPCS Code Update - October Edition - Correct Coding This article identifies changes to Level II Healthcare Common Procedure Coding System (HCPCS) codes for October 2021. 10/07/21
Local Coverage Determination Release for Notice - Transcutaneous Electrical Nerve Stimulators (TENS) This article informs suppliers about coverage of TENS for CLBP is no longer available under Coverage with Evidence Development. Per NCD 160.27, TENS is not reasonable and necessary for the treatment of CLBP under section 1862(a)(1)(A) of the Act. 10/07/21
RETIRED - PureWick Urine Collection System - Coding and Billing Instructions This article informs suppliers about correct coding of the PureWick Urine Collection System™. 10/07/21
Insulin Used with Continuous External Insulin Infusion Pumps Correct Coding - Revised This article reminds suppliers that payment for insulin under Part D is prohibited when there is coverage available under a Medicare Part B benefit. 09/30/21
Warranty, Reasonable Useful Lifetime (RUL), and the Minimum Lifetime Requirement (MLR) for Durable Medical Equipment - Correct Coding - Revised This article reminds suppliers about warranties, minimum lifetime requirements and reasonable useful lifetime requirements 09/30/21
Open Meeting Announcement - Nebulizers Proposed Local Coverage Determination (LCD) This article announces an open meeting for the Nebulizers proposed LCDs 09/30/21
Open Meeting Announcement - Pneumatic Compression Devices Proposed Local Coverage Determination (LCD) This article announces an open meeting for the Pneumatic Compression Devices proposed LCDs 09/30/21
Proposed Local Coverage Determinations (LCDs) Released for Comment - Nebulizers and Pneumatic Compression Devices This article announces two proposed LCDs for Nebulizers and Pneumatic Compression Devices and includes instructions for comments 09/30/21
2021 HCPCS Code Update - July Edition - Correct Coding - Revised This article identifies revised changes to Level II Healthcare Common Procedure Coding System (HCPCS) codes for July 2021 09/02/21
2020 HCPCS Code Update - October Edition - Correct Coding - Revised This article identifies revised changes to Level II Healthcare Common Procedure Coding System (HCPCS) codes for October 2020 09/02/21
L1690 Prefabricated Bilateral Lumbo-Sacral Hip Orthosis - Correct Coding - Revised The DME MACs and the Pricing, Data Analysis and Coding (PDAC) Contractor are providing this revised article to educate suppliers to correctly code products which are described by this L-code. 08/26/21
Sleep Test Requirements This article addresses sleep testing for positive airway pressure devices and oral appliance for obstructive sleep apnea and how those tests will continue to rely on a Medicare-covered diagnostic sleep test with qualifying values that is eligible for coverage and reimbursement by the A/B MAC contractor. 08/05/21
RETIRED - 2021 HCPCS Code Update - July Edition - Correct Coding This article identifies changes to Level II Healthcare Common Procedure Coding System (HCPCS) codes for July 2021 07/29/21
2021 HCPCS Code Update - April Edition - Correct Coding This article identifies changes to Level II Healthcare Common Procedure Coding System (HCPCS) codes for April 2021 07/29/21
RETIRED - 2020 HCPCS Code Update - October Edition - Correct Coding This article identifies changes to Level II Healthcare Common Procedure Coding System (HCPCS) codes for October 2020 07/29/21
Enteral Nutrition and Parenteral Nutrition - Final LCDs and Response to Comments (RTC) Articles Published This article announces the final LCDs for Enteral and Parenteral along with the Response to Comment documents. 07/22/21
RETIRED - Frequently Asked Questions - Philips Respironics Respiratory Products Recall - Revised This revised article provides updated questions and answers regarding the Philips Respironics respiratory products recall. 07/16/21
Incorrect Use of HCPCS Code A9279 - Correct Coding - Revised This revised article clarifies the use of HCPCS code A9279 regarding monitoring services. 07/01/21
RETIRED - Frequently Asked Questions - Philips Respironics Respiratory Products Recall This FAQ explains the next steps suppliers should take with this major recall. 06/25/21
Oral Appliances for Obstructive Sleep Apnea, Positive Airway Pressure (PAP) Devices for Obstructive Sleep Apnea and Respiratory Assist Devices - Final LCDs and Response to Comments (RTC) Articles Published This article announces the final LCDs for Oral Appliances for OSA, Positive Airway Pressure (PAP) Devices for OSA and Respiratory Assist Devices and the Response to Comments Articles. 06/24/21
Code Verification Review Requirement for Articulating Digit(s) and Prosthetic Hands - Revised To assist manufacturers and suppliers with correct coding, the DME MACs are requiring mandatory code verification review by the PDAC Contractor for upper extremity devices that might qualify for HCPCS codes L6880 and L6715 06/10/21
External Infusion Pumps & Glucose Monitors - Final LCDs and Response to Comments (RTC) Articles Published This article announces the final LCDs for External Infusion Pumps and Glucose Monitors and the Response to Comments Articles. 06/03/21
RETIRED - Code Verification Review Requirement for Articulating Digit(s) and Prosthetic Hands To assist manufacturers and suppliers with correct coding, the DME MACs are requiring mandatory code verification review by the PDAC Contractor for upper extremity devices that might qualify for HCPCS codes L6880 and L6715 06/03/21
Custom Fabricated Wheelchair Seat and Back Cushions - Correct Coding - Revised This article will discuss the information necessary for coding of custom fabricated wheelchair seat and back cushions. 05/13/21
RETIRED - Use of CR Modifier and "COVID-19" Narrative on Specified Claims Due to the COVID-19 PHE - Revised This bulletin article reminds suppliers to append the CR modifier and "COVID-19" narrative to claims for dates of service on or after March 1, 2020, where the coverage, coding or documentation requirements are impacted by the COVID-19 Public Health Emergency (PHE). 05/06/21
Enteral Nutrition and Parenteral Nutrition Proposed Local Coverage Determinations (LCDs) Open Meeting Agenda This article provides the agenda for the open meeting on the proposed Enteral and Parental LCDs 03/16/21
Oral Appliances for OSA, Positive Airway Pressure (PAP) Devices for the Treatment of OSA, and Respiratory Assist Devices Proposed Local Coverage Determinations (LCDs) Open Meeting Agenda This article provides the agenda for three proposed LCDs to including Oral Appliances for OSA, Positive Airway Pressure Devices, and Respiratory Assist Devices 03/16/21
RETIRED - Custom Fitted Orthotic HCPCS Codes Without a Corresponding Off-the-Shelf Code - Correct Coding This article identifies custom fit orthotic codes without a corresponding off-the-shelf code 03/11/21
RETIRED - Definitions Used for Off-the-Shelf versus Custom Fitted Prefabricated Orthotics (Braces) – Correct Coding - Revised This article provides the definitions of off-the-shelf versus custom fit prefabricated orthotics 03/11/21
Open Meeting Announcement - Enteral Nutrition and Parenteral Nutrition Proposed Local Coverage Determinations (LCDs) This article announces an open meeting for two proposed LCDs to including Enteral Nutrition and Parenteral Nutrition 02/25/21
Open Meeting Announcement - Oral Appliances for Obstructive Sleep Apnea, Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea, and Respiratory Assist Devices Proposed Local Coverage Determinations (LCDs) This article announces an open meeting for three proposed LCDs to including Oral Appliances for OSA, Positive Airway Pressure Devices, and Respiratory Assist Devices 02/25/21
Proposed Local Coverage Determinations (LCDs) Released for Comment - Enteral Nutrition, Oral Appliances for Obstructive Sleep Apnea, Parenteral Nutrition, Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea, and Respiratory Assist Devices This article announces five proposed LCDs for Enteral Nutrition, Parenteral Nutrition, Oral Appliances for OSA, Positive Airway Pressure Devices, and Respiratory Assist Devices 02/25/21
Items Provided on a Recurring Basis and Request for Refill Requirements - Annual Reminder - January 2021 Annual reminder for all DMEPOS items and supplies provided on a recurring basis, billing must be based on prospective, not retrospective use. 01/28/21
RETIRED - MyoPro® (Myomo, Inc.) Assist Device - Correct Coding - Revised This article provides the code descriptor changes for the MyoPro® upper extremity assist devices 01/28/21
RETIRED - Completion of Certificates of Medical Necessity (CMN) - Annual Reminder Annual reminder regarding the completion of the Certificate of Medical Necessity, commonly known as CMNs, which are documents used by the DME MACs to assist in gathering information about the medical necessity of an item. 01/28/21
Glucose Monitors and External Infusion Pumps Open Meeting Agenda This article provides the agenda for the upcoming Open Meeting on January 19, 2021 01/04/21
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