LCD and Policy Article Revisions Summary for April 19 2018 - JA DME

Outlined below are the principal changes to the DME MAC Local Coverage Determinations (LCDs) and Policy Articles (PAs) that have been revised and posted. The policies included are External Infusion Pumps, Glucose Monitors, Oxygen & Oxygen Equipment, Seat Lift Mechanisms, and Spinal Orthoses: TLSO and LSO. Please review the entire LCDs and related PAs for complete information.

External Infusion Pumps
LCD
Revision Effective Date: 01/01/2018
HCPCS CODES:
Removed: J1555 from Group 3: Paragraph
Added: J1555 to Group 3: Codes

04/19/2018: At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.

PA
Revision Effective Date: 01/01/2018
CODING GUIDELINES:
Added: Treprostinil to K0455
Added: HCPCS code J9039
Updated: Levodopa-Carbidopa UOS
Removed: Coding instructions for HCPCS Q9977 for DOS between July 01, 2015 through December 31, 2015

04/19/2018: At this time 21st Century Cures Act applies to new and revised LCDs that restrict coverage, which require comment and notice. This revision is to an article that is not a local coverage determination.

Glucose Monitors
LCD
Revision Effective Date: 01/12/2017
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
CPT/HCPCS Codes:
Revised: Incorporated K0554 into Group 1 Codes and HCPCS code K0553 into Group 2 Codes

04/19/2018: At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.

PA
Revision Effective Date: 01/12/2017
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: Date of inclusion in DME benefit
CODING GUIDELINES:
Added: Coding information for CGM, based on date of service

04/19/2018: At this time 21st Century Cures Act applies to new and revised LCDs that restrict coverage, which require comment and notice. This revision is to an article that is not a local coverage determination.

Oxygen and Oxygen Equipment
LCD
Revision Effective Date: 04/01/2018
Coding Information
Revised: Modifier QE, QF, QG
Added: Modifier QA, QB, QR

04/19/2018: At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.

PA
Revision History Effective Date: 04/01/2018
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES
Oxygen Equipment: Initial 36 months
Added: "the appropriate modifiers (QB or QF) must be used." in paragraph regarding flow rate greater than 4 LPM and also meets requirements for portable oxygen
Added: 42 CFR 410.38(g) language, previously in POLICY SPECIFIC DOCUMENTATION REQUIREMENTS section
CERTIFICATE OF MEDICAL NECESSITY
Added: Flow rate guidelines for beneficiaries who require differing day and night rates
CODING GUIDELINES
Revised: Flow rate modifiers for beneficiaries who require differing day and night rates
Revised: Coding guidelines for E1405 and E1406 to indicate that high flow rate modifiers (QB, QF, QG or QR) must not be used with these two HCPCS codes.

04/19/2018: At this time 21st Century Cures Act applies to new and revised LCDs that restrict coverage, which require comment and notice. This revision is to an article that is not a local coverage determination.

Seat Lift Mechanisms
LCD
Revision Effective Date: 01/01/2017:
Coverage Indications, Limitations and/or Medical Necessity
Revised: Typographical error Oorthotics to Orthotics

04/19/2018: At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.

PA
Revision History Effective Date: 01/01/2017
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES
Added: 42 CFR 410.38(g) language, previously in POLICY SPECIFIC DOCUMENTATION REQUIREMENTS section

04/19/2018: At this time 21st Century Cures Act applies to new and revised LCDs that restrict coverage, which require comment and notice. This revision is to an article that is not a local coverage determination

Spinal Orthoses: TLSO and LSO
LCD
Revision Effective Date: 01/01/2018
CODING INFORMATION:
Added: HCPCS codes L0622 and L0624 to Group 1 HCPCS Code table

04/19/2018: At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.

PA
Revision Effective Date: 01/01/2018
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: HCPCS codes L0622 and L0624 to custom fabricated codes
CODING GUIDELINES:
Added: Coding guidelines for maternity support garments
Added: HCPCS codes L0622 and L0624 to custom fabricated codes

04/19/2018: At this time 21st Century Cures Act applies to new and revised LCDs that restrict coverage, 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 PAs.  For complete information on any topic, you must review the LCDs and/or PAs.