LCD and Policy Article Revisions Summary for August 11 2016 - 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 Bowel Management Devices, Nebulizers and Oral Anti-Cancer Drugs. Please review the entire LCD and related PA for complete information.

Bowel Management Devices

LCD                                      

Revision Effective Date 07/01/2016

COVERAGE INDICATIONS, INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

Added:  Vaginal inserts and accessories information (Effective date 02/12/2015)

HCPCS MODIFIERS:

Deleted:  GA, GZ, GY modifiers

DOCUMENTATION REQUIREMENTS:

Revised: Standard documentation language to Orders, revise Proof of delivery instructions, and add Correct coding instructions (Effective date 04/28/2016)

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS

Deleted:  GA, GZ, GY modifiers section

Policy Article

Revision Effective Date: 07/01/2016

CODING GUIDELINES:

Added:  Coding guideline definition of vaginal insert (Effective date 02/12/2015)

Nebulizers

LCD

Revision Effective Date: 07/01/2016

COVERAGE INDICATIONS, INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

Revised: Standard documentation language - ACA requirements – Effective 04/28/16

Added: A7007 and A7017 related accessories table for E0572

Added: Denial verbiage for JW Modifier when coverage criteria not met - Effective 01/01/17

HCPCS MODIFIERS:

Added: JW Modifier – Effective January 1, 2017

DOCUMENTATION REQUIREMENTS:

Revised: Standard documentation language for orders and ACA requirements, added New order requirements, and Correct coding instructions; revised Refill requirements to change "should" to "must",  revised Proof of delivery instructions – Effective 04/28/16

Added: JW Modifier instructions – Effective January 1, 2017

Policy Article

Revision Effective Date: 07/01/2016

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

Added: Standard documentation language-adding Statutory Prescription (Order) Requirements, revising ACA requirements – Effective 04/28/16

Revised: Dispensing fee date example from 04/20 to 04/10

Oral Anticancer Drugs

LCD

Revision Effective Date: 07/01/2016

COVERAGE INDICATIONS, INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

Revised: Standard Documentation language for Refill Requirements (Effective 04/28/16)

DOCUMENTATION REQUIREMENTS:

Revised: Standard Documentation language in orders, added New order requirements; revised language in Refill documentation, Proof of delivery instructions, and added Correct coding instructions (Effective 04/28/16)

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

Updated: "should" to "must" for electronic claim narrative requirement

Policy Article

Revision Effective Date: 10/01/2015:

Covered ICD-10 Codes:

Added: C7B.00, C7B.01, C7B.02, C7B.03, C7B.04 and C7B.09 to Groups 2 and 8 (Effective 10/01/2015)

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