LCD and Policy Article Revisions Summary for November 10 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, Commodes, Eye Prostheses, Facial Prostheses, and Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea.  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:

Removed:  Coverage statement for vaginal inserts and related accessories; they are not DME MAC Jurisdiction (Effective date 02/12/2015)

SOURCES OF INFORMATION AND BASIS FOR DECISION:

Removed: Links

Policy Article

Revision Effective Date: 07/01/2016

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

Added:  Jurisdictional statement for vaginal inserts (Effective date 02/12/2015)

CODING GUIDELINES:

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

Commodes

LCD

Revision Effective Date: 07/01/2016

DOCUMENTATION REQUIREMENTS:
Revised: Standard Documentation Language Effective 04/28/2016

Policy Article

Revision Effective Date: 07/01/2016

Updated: Title to remove effective date

Eye Prostheses

LCD

Revision Effective Date: 07/01/2016

DOCUMENTATION REQUIREMENTS:
Revised: Standard Documentation language Effective 04/28/2016

Added: Repair/Replacement Requirements

Policy Article

Revision Effective Date: 07/01/2016
NON-MEDICAL NECESSITY COVERAGE & PAYMENT RULES:
Added: Instructions for services and items included in the allowance of the eye prostheses, and not separately billable

Facial Prostheses

LCD

Revision Effective Date: 07/01/2016

DOCUMENTATION REQUIREMENTS:
Revised: Standard Documentation language Effective 04/28/2016

Added: Repair/Replacement Requirements

Policy Article

Revision Effective Date: 07/01/2016
Updated: Title to remove effective date

Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea

LCD

Revision Effective Date: 07/01/2016

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

Added: American Osteopathic Association to physician credentials for interpreting sleep test

Revised: Standard Documentation language - ACA requirements Effective 04/28/2016

DOCUMENTATION REQUIREMENTS:

Revised: Standard documentation language to revise Refill documentation changing "should to must", ACA requirements, and Proof of deliver instructions; added New order requirements and Correct coding instructions (Effective 04/28/2016)

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)

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.