LCD and Policy Article Revision Summary for October 9 2014 - JA DME

Outlined below are the principal changes to a DME MAC Local Coverage Determinations (LCD) and Policy Article (PA) that has been revised and posted.  Please review the entire LCD and related PA for complete information.

Respiratory Assist Devices

LCD

Revision Effective Date: 12/01/2014

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

Revised: Definitions of Central Sleep Apnea and Complex Sleep Apnea to include a CAHI index and expands signs and symptoms that describe the conditions

Revised: Severe COPD to clarify that definitive testing is not necessary to exclude OSA when the clinical picture is sufficient

Revised: Severe COPD to clarify that nocturnal oximetry is a cumulative 5 minutes of testing

Revised: Hypoventilation Syndromes to remove FEV1

Revised: PSG testing to also include HST testing when used in the in-patient hospital setting to establish or rule out the diagnosis of OSA

Added: Ventilator section based upon NCD and April 2014 coding and coverage article

Added: Sleep Test coverage and payment rules

Policy Article

Revision Effective Date: 12/01/2014

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES: 
Added: ACA 6407 prescriber requirements

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