Article Detail - JD DME

Original Effective Date: 05/10/2012
Revision Effective Date: 11/01/2013

Outlined below are the principal changes to DME MAC Local Coverage Determinations (LCDs) and Policy Articles (PAs) that have been revised and posted. Please review the entire LCD and each related PA for complete information.

Ankle-Foot/Knee-Ankle-Foot Orthosis
LCD
Revision Effective Date: 07/01/2012
INDICATIONS AND LIMITATIONS OF COVERAGE:
Added: Coverage of concentric adjustable torsion joints (Effective 3/13/2012)
DOCUMENTATION REQUIREMENTS:
Added: Documentation of custom-fabricated items

POLICY ARTICLE
Revision Effective Date: 07/01/2012
CODING GUIDELINES:
Added: Coding guidelines for L1906
Revised: Coding guidelines for concentric adjustable torsion joints (Effective 3/13/2012)
Added: Coding verification for codes L1906, L1930, L1932, L1940, L1960, L1970 and L1971
Added: Repair and replacement guidelines


External Breast Prostheses
LCD
Revision Effective Date: 06/01/2012
INDICATIONS AND LIMITATIONS OF COVERAGE AND MEDICAL NECESSITY:
Revised: Order requirement language to specify a "detailed written order"
Added: Refill requirements per PIM 5.2.6 (effective 08/02/2011 per CR7452)
DOCUMENTATION REQUIREMENTS:
(Note: The effective date above is not applicable to this section. These revised and added requirements are existing Medicare requirements which are now included in the LCD for easy reference)
Revised: Prescription requirements
Added: Refill requirements, general medical record information requirements, continued use and continued need requirements, and proof of delivery requirements

POLICY ARTICLE
Revision Effective Date: 06/01/2012
NON-MEDICAL NECESSITY AND COVERAGE AND PAYMENT RULES:
Revised: Preamble language
CODING GUIDELINES
Revised: Descriptions for L8000, L8001 & L8002

Glucose Monitors
LCD
Revision Effective Date: 07/01/2012
INDICATIONS AND LIMITATIONS OF COVERAGE:
Revised: Basic coverage criteria for glucose monitor and supplies
Revised: Coverage criteria for high utilization
Revised: Order requirements language to specify a "detailed written order"
Changed: Word "Patient" to "Beneficiary"
Clarified: Coverage of laser lancing devices and lens shield cartridges
DOCUMENTATION REQUIREMENTS:
(Note: The effective date above is not applicable to this section. These revised and added requirements are existing Medicare requirements which are now included in the LCD for easy reference)
Revised: Prescription requirements
Added: Medical Record Information
Added: Documentation of beneficiary training
Added: Documentation requirements for high utilization


Knee Orthoses
LCD
Revision Effective Date: 07/01/2012
INDICATIONS AND LIMITATIONS OF COVERAGE:
Revised: Order requirements language to specify a "detailed written order"
Added: Coverage for concentric adjustable torsion joints (Effective 3/13/2012)
Added: Code L2755 to Addition Codes – Eligible for Separate Payment table
Added: ICD-9 codes 733.81-733.82 and 905.4 for L1830, L1832, L1843, L1845 to coverage table per request for reconsideration.
Changed: Word "Patient" to "Beneficiary"
HCPCS CODES AND MODIFIERS
Added: Code L2755
ICD-9 CODES THAT SUPPORT MEDICAL NECESSITY:
Added: ICD-9 codes 733.81-733.82 and 905.4 for L1830, L1832, L1834, L1843, L1844, L1845, L1846 per request for reconsideration.
DOCUMENTATION REQUIREMENTS:
(Note: The effective date above is not applicable to this section. These revised and added requirements are existing Medicare requirements which are now included in the LCD for easy reference)
Added: Refill requirements, general medical record information requirements, continued use and continued need requirements, and proof of delivery requirements

POLICY ARTICLE
Revision Effective Date: 07/01/2012
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: Reference to LCD for R & N requirements
Changed: Patient to Beneficiary
CODING GUIDELINES:
Added: Definition of code L2755
Added: Coding guidelines for concentric adjustable torsion joints (Effective 3/13/2012)


Manual In-exsufflation Devices
LCD
Revision Effective Date: 05/01/2012
INDICATIONS AND LIMITATIONS OF COVERAGE:
Revised: Prescription requirement
ICD-9 CODES THAT SUPPORT MEDICAL NECESSITY:
Added: ICD-9 359.71
DOCUMENTATION REQUIREMENTS:(Note: The effective date above is not applicable to this section. These revised and added requirements are existing Medicare requirements which are now included in the LCD for easy reference)
Revised: Prescription requirements
Added: Refill requirements, general medical record information requirements, continued use and continued need requirements, and proof of delivery requirements


Manual Wheelchair Bases
LCD
Revision Effective Date: 05/01/2012
INDICATIONS AND LIMITATIONS OF COVERAGE:
Revised: Order requirement language to specify a "detailed written order"
DOCUMENTATION REQUIREMENTS:(Note: The effective date above is not applicable to this section. These revised and added requirements are existing Medicare requirements which are now included in the LCD for easy reference)
Revised: Prescription requirements
Added: General medical record information requirements, continued use and continued need requirements, and proof of delivery requirements
Removed: paragraph about individual consideration and changed "patient" to "beneficiary".
Added: Clarified Home Assessment documentation

POLICY ARTICLE
Revision Effective Date: 05/01/2012
CODING GUIDELINES:
Added general language, PDAC verification and E1161 to language about wheel design.
Changed: DMERC to DME MAC

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