LCD and Policy Article Revisions Summary for October 6 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 External Infusion Pumps, Glucose Monitors, Knee Orthoses, Oral Anticancer Drugs, Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics), and Therapeutic Shoes for Persons with Diabetes.  Please review the entire LCD and related PA for complete information.

External Infusion Pumps
LCD                         
Revision Effective Date: 10/01/2016
ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:

Added: New ICD-10 codes to Group 1 per Annual ICD-10 Codes Updates

Deleted: Non-valid ICD-10 codes per Annual ICD-10 Codes Updates

Glucose Monitors
LCD
Revision Effective Date: 10/01/2016

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

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

ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:

Added: New ICD-10 codes
Deleted: Non-valid ICD-10
Revised: ICD-10 code descriptions

DOCUMENTATION REQUIREMENTS:
Revised: Standard documentation language for orders, added New order requirements, and Correct coding instructions; revised Proof of delivery instructions – Effective 04/28/16

Policy Article
Revision Effective Date: 07/01/2016

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

Revised Standard Language to add Statutory Prescription (Order) Requirements, revised Face to Face and ACA requirements (Effective 04/28/2016)

Knee Orthoses
LCD
Revision Effective Date: 10/01/2016

ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:

Added: ICD-10 Codes G57.03 & G57.23 to Group 4 per annual ICD-10 updates

Deleted: ICD-10 Codes T84.042A, T84.043S from Groups 2 and 4 per annual ICD-10 updates

Policy Article
Revision Effective Date: 10/01/2016:

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

Removed: Counterforce coverage requirement (does not apply to this policy)

CODING GUIDELINES:

Removed: Counterforce from the description of the brace

Oral Anticancer Drugs
Policy Article
Revision Effective Date: 10/01/2016

ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:

Added: New ICD-10 Code per Annual ICD-10 Codes Updates in Group 2, 3, 4 and 9

Revised: ICD-10 Code descriptions per Annual ICD-10 Codes Updates

Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics)
Policy Article
Revision Effective Date: 10/01/2016:

ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:
Added: New ICD-10 codes per Annual ICD-10 Codes Updates
Deleted: Non-valid ICD-10 codes per Annual ICD-10 Codes Updates
Revised: ICD-10 code descriptions per Annual ICD-10 Codes Updates
Deleted: ICD-10 codes per Coding Revisions to National Coverage Determinations (effective 10/01/2015)

Therapeutic Shoes for Persons with Diabetes
LCD
Revision Effective Date: 07/01/2016

DOCUMENTATION REQUIREMENTS:
Revised: Standard documentation language for orders, added New order requirements, and Correct coding instructions; revised Proof of delivery instructions and removed Method 3 as it does not apply – Effective 04/28/16

Policy Article
Revision Effective Date: 10/01/2016:
ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:

Added: New ICD-10 codes
Deleted: Non-valid ICD-10

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.