Policy Article Revisions Summary for April 5 2018 - JA DME

Outlined below are the principal changes to the DME MAC Policy Articles (PAs) that have been revised and posted. The policies included are Ankle-Foot/Knee-Ankle-Foot Orthosis, Bowel Management Devices, Cervical Traction Devices, Enteral Nutrition, Eye Prosthesis, High Frequency Chest Wall Oscillation Devices, Hospital Beds And Accessories, Immunosuppressive Drugs, Mechanical In-exsufflation Devices, Respiratory Assist Devices. Please review the entire LCDs and related PAs for complete information.

Ankle-Foot/Knee-Ankle-Foot Orthosis
PA
Revision Effective Date: 01/01/2017
CODING GUIDELINES:
Revised: Code pairs to accurately reflect parallel codes
Updated: HCPCS code narratives to align with HCPCS code table
Added: Walking boot add-on bundling information

04/05/2018:  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.

Bowel Management Devices
PA
Revision Effective Date: 01/01/2017
CODING GUIDELINES:
Added: Peristeen^® coding guidelines

04/05/2018: 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.

Cervical Traction Devices
PA  
Revision Effective Date: 01/01/2017
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES
Added: 42 CFR 410.38(g) language, previously in Policy Specific Documentation Requirement section.

04/05/2018: 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.

Enteral Nutrition
PA
Revision Effective Date: 01/01/2017
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Updated: "patient" to "beneficiary
CODING GUIDELINES:
Revised: Typographical, updated code set to represent a span

04/05/2018: 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.

Eye Prosthesis
PA
Revision Effective Date: 01/01/2017
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: Information regarding implanted components

04/05/2018: 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.

High Frequency Chest Wall Oscillation Devices
PA
Revision Effective Date: 01/01/2018
CODING GUIDELINES:
Added: Coding guidelines for HCPCS codes E0483, A7025, A7026

04/05/18: 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.

Hospital Beds And Accessories
PA
Revision Effective Date: 01/01/2017
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES
Added: 42 CFR 410.38(g) language, previously in Policy Specific Documentation Requirement section

04/05/2018: 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.

Immunosuppressive Drugs
PA
Revision Effective Date: 01/01/2017
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES
Revised: Corrected typo inbeneficiary and outbeneficiary to inpatient and outpatient

04/05/2018: 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.

Mechanical In-exsufflation Devices
PA
Revision Effective Date: 01/01/2017
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES
Added: 42 CFR 410.38(g) language, previously in Policy Specific Documentation Requirement section

04/05/2018: 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.

Respiratory Assist Devices
PA
Revision 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.

04/05/2018: 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 no 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.