Policy Article Revisions Summary for April 12 2018 - JA DME
Policy Article Revisions Summary for April 12, 2018
Outlined below are the principal changes to the DME MAC Policy Articles (PAs) that have been revised and posted. The policies included are Facial Prostheses, Knee Orthoses, Lower Limb Prostheses, Manual Wheelchair Bases, Nebulizers, Pneumatic Compression Devices, Power Mobility Devices, Speech Generating Devices, Tracheostomy Care Supplies, Wheelchair Options/Accessories, and Wheelchair Seating. Please review the entire LCDs and related PAs for complete information.
Facial Prostheses
PA
Revision Effective Date: 01/01/2018
Added: Clarifying language regarding use of miscellaneous code L8048
04/12/2018: 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.
Knee Orthoses
PA
Revision Effective Date: 01/01/2017
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Revised: "Spinal" to "knee", in reference to OTS language
CODING GUIDELINES:
Update: Velcro and Kevlar to include trademark
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.
Lower Limb Prostheses
PA
Revision Effective Date: 01/01/2018
CODING GUIDELINES:
Revised: "liner" to "insert" for continuity of terms
Added: Coding guidelines for prosthetic covers (L5704-L5707) and Protective outer surface covering systems (L5962, L5964, and L5966)
Added: Bundling table for Coding Batteries and Chargers Concurrently With a Powered Base Item
04/12/2018: 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.
Manual Wheelchair Bases
PA
Revision Effective Date: 01/01/2018
CODING GUIDELINES:
Added: Clarification of what is included in a manual wheelchair base code
Added: Clarification of titanium unbundling in manual wheelchair bases
04/12/2018: 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.
Nebulizers
PA
Revision Effective Date: 01/01/2017
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Revised: Dispensing Fee billing timeline for refill prescriptions
CODING GUIDELINES:
Added: Billing instructions for accessories used in conjunction with E0574
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.
Pneumatic Compression Devices
PA
Revision Effective Date: 01/01/2017
CODING GUIDELINES:
Revised: Coding guidelines for clarification
04/12/2018: 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.
Power Mobility Devices
PA
Revision Effective Date: 01/01/2018
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: 42 CFR(c) and (g) language, previously in Policy Specific Documentation section
POLICY SPECFIC DOCUMENTATION:
Revised: ADMC eligible base codes to conform to the Condition of Payment PA Program
Added: Prior Authorization of Power Mobility Devices (PMD) Demonstration and Condition of Payment PA Program information
04/12/2018: 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.
Speech Generating Devices
PA
Revision Effective Date: 01/01/2017
CODING GUIDELINES:
Added: Coding Verification Review for E2510
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.
Tracheostomy Care Supplies
PA
Revision Effective Date: 01/01/2017
CODING GUIDELINES:
Added: Clarification that tracheostomy tubes (A7520, A7521, 7522) are all-inclusive
04/12/2018: 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.
Wheelchair Options/Accessories
PA
Revision Effective Date: 01/01/2018
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: 42 CFR language previously in Policy Specific Documentation section
CODING GUIDELINES:
Revised: Coding Guidelines for E1012
Added: PDAC contact information
04/12/2018: 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.
Wheelchair Seating
PA
Revision Effective Date: 01/01/2018
CODING GUIDELINES:
Revised: Positioning cushion language placement for clarification
Added: Wheelchair seat and back cushion codes are all-inclusive
04/12/2018: 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.
