Article Detail - JD DME

Outlined below are the principal changes to the DME MAC Policy Articles (PAs) that have been revised and will be posted November 24, 2022. The policies included are Intravenous Immune Globulin and Standard Documentation Requirements for All Claims Submitted to DME MACs. Please review the entire Local Coverage Determinations (LCDs) and related PAs for complete information.

Intravenous Immune Globulin

PA

Revision Effective Date: 10/01/2022
ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY:
Added: ICD-10-CM code D81.82 to Group 1 codes per update to Medicare Benefit Policy Manual, Chapter 15, section 50.6

11/24/2022: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Standard Documentation Requirements for All Claims Submitted to DME MACs

PA

Revision Effective Date: 01/01/2023
MEDICAL RECORD DOCUMENTATION:
Added: “(for DOS prior to 01/01/2023)” after “CMN”
Added: “prior to DOS 01/01/2023” in the second reminder bullet after “CMN”
CONTINUED MEDICAL NEED:
Added: "of supplies" to the end of the first bullet after "refills"
Added: Bullet justifying continued medical need to include an order/prescription for repairs
Added: “obtained prior to DOS 01/01/2023,” in the fourth bullet of items that justify continued need after “CMN or DIF”
CERTIFICATE OF MEDICAL NECESSITY (CMN) & DME INFORMATION FORM (DIF):
Added: Billing information relevant to CMNs and DIFs, for DOS affected by the CMN and DIF elimination
REPLACEMENT:
Added: “(prior to DOS 01/01/2023)” after “CMN”
11/24/2022: At this time 21st Century Cures Act applies to new and revised LCDs 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.

With the update(s) listed above, Noridian would like to remind users how to find the policy that was previously effective. When billing, the supplier should follow guidance that was effective on the date of service. The below steps can be followed to find all previous policies:

1. Open the currently effective policy on the Medical Coverage Database (MCD)
   1. Links to the MCD can be found on the Active LCDs page on the Noridian website
      1. There is a link at the top of the Active LCD page that goes to a full list of the LCDs or PAs, depending on which link is selected OR
      2. There are direct links to all LCDs under the ‘LCD ID number and Effective Date’ column
2. Scroll down to the bottom of the policy
3. Find the section labeled Public Version(s)
4. Look for the link to the policy that was effective on the dates of service in question

Click on hyperlink to go to the policy