Policy Article Revisions Summary for February 8, 2024 - JA DME

Joint DME MAC Publication
Posted February 8, 2024

Outlined below are the principal changes to the DME MAC Policy Articles (PAs) that have been revised and posted. The policies included are External Infusion Pumps and Standard Documentation Requirements for All Claims Submitted to DME MACs. Please review the entire Local Coverage Determinations (LCDs) and related PAs for complete information.

External Infusion Pumps

PA

Revision Effective Date: 01/12/2024
ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY:
Added: "J1575" to Group 6 Paragraph

02/08/2024: 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.

Standard Documentation Requirements for All Claims Submitted to DME MACs

PA

Revision Effective Date: 01/01/2024
DOCUMENTATION REQUIREMENTS:
Removed: "a CMN (if applicable), a DIF (if applicable)"
MEDICAL RECORD DOCUMENTATION:
Removed: "and CMNs (for DOS prior to 01/01/2023)"
Removed: "including CMS CMNs prior to DOS 01/01/2023"
CONTINUED MEDICAL NEED:
Removed: "A properly completed CMN or DIF obtained prior to DOS 01/01/2023, with an appropriate length of need specified"
CERTIFICATE OF MEDICAL NECESSITY (CMN) & DME INFORMATION FORM (DIF):
Removed: Section header and entire section
REPAIRS/REPLACEMENTS:
Removed: "CMN and/or"
Removed: "and/or new CMN (prior to DOS 01/01/2023)"

02/08/2023: 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.