LCD and Policy Article Revisions Summary for March 20, 2014

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

Cervical Traction Devices

LCD

Revision Effective Date:  11/01/2013 (March 2014 Publication)

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

Added: Information that item(s) in policy are subject to ACA 6407 requirements (effective 07/01/2013)

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

Added: ACA 6407 information (requirements effective 07/01/2013)

Policy Article:

Revision Effective Date: 11/01/2013 (March 2014 Publication)

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: ACA 6407 requirements (effective 07/01/2013)

Lower Limb Prostheses

LCD

Revision Effective Date: 01/01/2014

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

Added: Non-coverage guidance for L5969

HCPCS CODES AND MODIFIERS:
Added: L5969
Revised: HCPCS Narrative of L5668

Policy Article

Revision Effective Date: 01/01/2014

CODING GUIDELINES:

Added: Instructions for use of code L5969

Added: Requirement for PDAC coding verification for L5969

Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics)

LCD

Revision Effective Date: 01/01/14
HCPCS CODES AND MODIFIERS:
Added: Q0161
Discontinued: Q0165, Q0168, Q0170, Q0171, Q0172, Q0176 and Q0178

Power Mobility Devices

LCD
Revision Effective Date: 11/01/2013 (March 2014 Publication)

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

Added: Information that item(s) in policy are subject to ACA 6407 requirements (effective 07/01/2013)

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

Added: ACA 6407 information (requirements effective 07/01/2013)

Policy Article

Revision Effective Date: 11/01/2013 (March 2014 Publication)

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: ACA 6407 requirements (effective 07/01/2013)

Pressure Reducing Support Surfaces – Group 1

LCD

Revision Effective Date: 11/01/2013 (March 2014 Publication)

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

Added: Information that item(s) in policy are subject to ACA 6407 requirements (effective 07/01/2013)

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

Added: ACA 6407 information (requirements effective 07/01/2013)

Policy Article

Revision Effective Date: 11/01/2013 (March 2014 Publication)
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: ACA 6407 requirements (effective 07/01/2013)

Respiratory Assist Devices

LCD

Revision Effective Date: 11/01/2013 (March 2014 Publication)

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

Added: Information that item(s) in policy are subject to ACA 6407 requirements (effective 07/01/2013)

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

Added: ACA 6407 information (requirements effective 07/01/2013)

Policy Article

Revision Effective Date: 11/01/2013 (March 2014 Publication)
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: ACA 6407 requirements (effective 07/01/2013)

Seat Lift Mechanisms

LCD

Revision Effective Date: 11/01/2013 (March 2014 Publication)

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

Added: ACA 6407 information (requirements effective 07/01/2013)

Policy Article

Revision Effective Date: 11/01/2013 (March 2014 Publications)

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: ACA 6407 requirements (effective 07/01/2013)

Transcutaneous Electrical Nerve Stimulators (TENS)

LCD
Revision Effective Date: 11/01/2013 (March 2014 Publication)

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

Revised: Specific ICD-9 diagnosis codes contained in the narrative are replaced with a reference to the applicable diagnosis code tables

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

Added: ACA 6407 information (requirements effective 07/01/2013)

Policy Article

Revision Effective Date: 11/01/2013 (March 2014 Publication)

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Revised: ACA 6407 requirements (effective 07/01/2013)

Wheelchair Seating

LCD

Revision Effective Date: 11/01/2013 (March 2014 Publication)

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

Added: Information that item(s) in policy are subject to ACA 6407 requirements (effective 07/01/2013)
Revised: Specific ICD-9 diagnosis codes contained in the narrative are replaced with a reference to the applicable diagnosis code tables

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

Added: ACA 6407 information (requirements effective 07/01/2013)
Revised: Specific ICD-9 diagnosis codes contained in the narrative are replaced with a reference to the applicable diagnosis code tables

Policy Article

Revision Effective Date: 11/01/2013 (March 2014 Publication)

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: ACA 6407 requirements (effective 07/01/2013)

CODING GUIDELINES:

Changed: Clerical change from "vertical" to "horizontal" regarding HCPCS E2613-E2616

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

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