LCD and Policy Article Revisions Summary for April 17, 2025 - JA DME

Joint DME MAC Publication
Posted April 17, 2025

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 policies included are Immunosuppressive Drugs and Standard Documentation Requirements for All Claims Submitted to DME MACs. Please review the entire LCD and PA for complete information.

Immunosuppressive Drugs

LCD

Revision Effective Date: 04/01/2025
HCPCS CODES:
Added: HCPCS code J7521

04/17/2025: 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.

Standard Documentation Requirements for All Claims Submitted to DME MACs

PA

Revision Effective Date: 01/01/2024
MEDICAL RECORD DOCUMENTATION:
Added: Reference to the Social Security Act section 1834(h)(5) regarding documentation created by orthotists and prosthetists shall be considered part of the individual’s medical record to support documentation created by the treating practitioner as clarification

04/17/2025: 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.