Medical Director Articles - 2014

 
Title Brief Description Last Updated
Correct Coding - Fitness Monitoring Technologies The DME MACs have received inquiries about coverage of fitness and rehabilitation tracking (FRT) technologies such as the FitBit, WeGo, Fuelband and other devices such as pedometers, heart rate monitors, and GPS watches.  12/18/14
Correct Coding – Integrated Respiratory Products The DME MACs have had multiple inquiries about the coding of products where multiple functions, each with a separate HCPCS code, are incorporated into a single product 12/18/14
RETIRED - Coverage and Correct Coding of Continuous Glucose Monitoring Devices Continuous glucose monitoring (CGM) devices measure glucose in the interstitial fluid, not capillary blood, providing interstitial glucose readings every few minutes. 12/18/14
Policy Article Revision – Vacuum Erection Devices (VED) The DME MACs have revised the Coding Guidelines in the related Policy Article for Vacuum Erection Devices (VED). 11/26/14
RETIRED - Correct Coding - Myopro Assist Device The DME MACs have evaluated the MyoPro upper extremity assist device and determined that it falls within the Durable Medical Equipment (DME) benefit category.  11/20/14
RETIRED - Correct Coding - External Infusion Pumps, Supplies and Drug A recent examination of CERT reviews for EIP claims has identified common errors in the information submitted in support of claims payment. 11/20/14
RETIRED - Correct Coding - Medicare Coverage for Shoes Medicare has limited coverage provisions for shoes used by beneficiaries. 11/20/14
E1825, E1830 and E1831 and Use of Modifiers Effective for dates of service on or after January 1, 2015, devices coded with HCPCS code E1825, E1830 and E1831 must use a modifier when billing this code. 11/13/14
RETIRED - Correct Coding - Oral Anticancer Drugs and PDAC's NDC/HCPCS Crosswalk Listings If a supplier bills an oral anticancer drug with an NDC number that is not on the NDC/HCPCS crosswalk list, the claim will receive a front-end reject by CEDI. 10/30/14
RETIRED - ACA Requirement for Indicating Receipt Date of Documentation With the implementation of Affordable Care Act (ACA) Section 6407, there are LCDs and related policy articles that require suppliers to receive clinical documentation and orders within a specific period of time. 10/30/14
RETIRED - Pneumatic Compression Devices LCD – Implementation Delayed The Pneumatic Compression Devices Local Coverage Determination (LCD) and related Policy Article (PA) scheduled to take effect for dates of service on or after November 1, 2014 are being delayed. 10/20/14
LCD and Policy Article Revision Summary for October 9, 2014 The principal changes to the policy for Respiratory Assist Devices are outlined. 10/9/14
RETIRED - Correct Coding – Cefaly ® The Cefaly ® device is a transcutaneous electrical nerve stimulator that is applied to the forehead using a self-adhesive electrode positioned bilaterally over the upper branches of the trigeminal nerve. 10/2/14
LCD and Policy Article Revisions Summary for October 2, 2014 The principal changes to the policies for External Infusion Pumps, Knee Orthoses and Therapeutic Shoes or Persons with Diabetes are outlined. 10/2/14
Coverage Reminder - Negative Pressure Wound Therapy Devices (NPWT) - Revised A recent examination of CERT reviews for NPWT claims has identified common errors in the information submitted in support of claims payment. 10/2/14
ICD-10 Updates to Local Coverage Determinations (LCDs) and Policy Articles (PAs) - Updated To keep separate the ICD-9s from the ICD-10s, all ICD-10 LCDs and PAs (with and without diagnosis codes) have been assigned new ID numbers. 10/2/14
Correct Coding – Palatal Lift Prosthesis - Revised A palatal lift prosthesis is a dental appliance that is used to support the soft palate in individuals lacking the normal muscle function necessary to maintain the soft palate in its normal position. 9/25/14
RETIRED - Pneumatic Compression Devices (PCD) – Response to Comments Summary When the DME Contractor Medical Directors published the Proposed LCD for Pneumatic Compression Devices (PCDs) in 2011, there had been a period of several years when we had regularly received requests for coverage of PCDs for peripheral arterial disease from a number of those treating these conditions, indicating the technology and its acceptance had significantly advanced and was becoming more generally accepted. 9/11/14
LCD and Policy Article Summary for September 11, 2014 – Draft Released to Final Draft Pneumatic Compression Devices (PCD) Local Coverage Determination and Policy Article have been finalized. 9/11/14
RETIRED - Coverage Reminder – Speech Generating Devices - Revised CMS National Coverage Determination for Speech Generating Devices specifies that in order for a speech generating device to be considered for reimbursement under the DME benefit, it must be a "dedicated" device. 9/4/14
ACA 6407 Requirements – Corrections and Amendments to the Face-To-Face Visit and WOPD The Affordable Care Act Section 6407 requires that the treating physician conduct a face-to-face examination and provide a written order prior to delivery (WOPD) for certain items of durable medical equipment (DME). 8/28/14
Correct Coding- Vibration Therapy Devices Vibration therapy is the application of a vibratory stimulation to the body. It can be applied as in a variety of ways, ranging from whole-body vibration to stimulation of local areas such as joints, hands, face, etc. 8/21/14
Written Order Prior to Delivery - Corrections to Document WOPD is a long-standing statutory requirement for certain items of durable medical equipment. 8/7/14
Proof of Delivery - Requirements for Signature and Date Auto-filling the date of delivery on delivery documentation or Proof of Delivery (POD) is a common business practice for many DMEPOS suppliers. 8/7/14
LCD and Policy Article Revisions Summary for July 24, 2014 The principal changes to the policies for Immunosuppressive Drugs and Group 2 Pressure Reducing Support Surfaces are outlined. 7/24/14
Policy Reminder – PAP Devices – Continued Coverage beyond the First Three Months of Therapy A review of recent appeals information has identified denials associated with demonstrating compliance with the PAP LCD requirements for continued coverage after the initial three months rental. 7/17/14
RETIRED - Positive Airway Pressure Device and Respiratory Assist Device - Nasal Interfaces and Liners – Revised There are two types of nasal interfaces that are used with a Positive Airway Pressure (PAP) device or a Respiratory Assist Device (RAD) - a nasal mask and cannula-type interface. 7/10/14
Orthoses/Prostheses - Coding for Professional Services/Fabrication Supplies - Republished HCPCS codes L4205 and L7520 may only be billed for time involved with the actual repair of an orthosis or prosthesis, respectively, or for medically necessary adjustments made more than 90 days after delivery. 7/10/14
RETIRED - FES - Coverage and HCPCS Coding - Revised In April 2003 CMS issued an NCD establishing coverage for FES to enable spinal cord injured patients to walk. 7/10/14
RETIRED - Ankle-Foot Orthoses: Walking Boots - Coverage and Coding Issues - Revised HCPCS codes L4360, L4361, L4386 and L4387 describe an ankle-foot orthosis commonly referred to as a walking boot. 7/10/14
Orthoses: Replacement of Components Clarification – Republished The allowance for a prefabricated orthoses includes all components provided at the time of initial issue including, but not limited to, soft interfaces, straps, closures, etc. 7/10/14
Reminder – Oxygen Equipment and Contents Delivery Suppliers are reminded that they cannot require a beneficiary to pick up oxygen equipment and oxygen contents at the supplier's location or a central dispensing facility. 6/26/14
RETIRED - Supplier Exit from Oxygen Equipment Business – Revised CMS issued instructions to the DME MACs to process claims for replacement oxygen and oxygen equipment in the event that a supplier exits the Medicare oxygen business, whether voluntarily or due to revocation of billing privileges, and is no longer able to continue furnishing oxygen and oxygen equipment. 6/19/14
RETIRED - Correct Coding – Billing of HCPCS code E0986 E0986 is a push-rim activated power assist option for a manual wheelchair in which sensors embedded in specially designed wheels determine the force that is exerted by the beneficiary upon the wheel. 6/19/14
LCD and Policy Article Summary for June 12, 2014 – Drafts Released to Final The TEJSD, TTFT and VED draft LCDs and Policy Articles have been finalized. 6/12/14
RETIRED - Vacuum Erection Device – Coding Verification Review Requirement The Vacuum Erection Devices LCD related Policy Article Coding Guidelines section contains additional guidance on the proper coding of products coded L7900 and L7902. 6/12/14
VED Response to Comments All commenters presented reasons to allow coverage primarily centered on review of published evidence available as of the date of their comment and/or their empirical experience of the effectiveness of the therapy. 6/12/14
TEJSD Response to Comments All commenters presented reasons to allow coverage primarily centered on review of published evidence available as of the date of their comment and/or their empirical experience of the effectiveness of the therapy. 6/12/14
TTFT Response to Comments All commenters presented reasons to allow coverage primarily centered on review of published evidence available as of the date of their comment and/or their empirical experience of the effectiveness of the therapy. 6/12/14
RETIRED - In-Person Visit Requirement for Section 6407 of the Affordable Care Act – Clarification Section 6407 of the Affordable Care Act (ACA 6407) requires that an in-person or face-to-face encounter must occur within the six months preceding the written order. 5/29/14
RETIRED - Face-to-Face Examination and Prescription Requirements Prior to the Delivery of Certain DME Items Specified in the ACA – Revised As a condition for payment, Section 6407 of the Affordable Care Act (ACA) requires that a physician (MD, DO or DPM), physician assistant (PA), nurse practitioner (NP) or clinical nurse specialist (CNS) has had a face-to-face examination with a beneficiary within the six (6) months prior to the written order for certain items of DME. 5/29/14
Face-to-Face Written Order Prior to Delivery - Dear Physician Letter For certain specified items of durable medical equipment the Affordable Care Act requires that an in-person, face-to-face examination (F2F) documenting the need for the item must have occurred sometime during the six (6) months prior to the order for the item. 5/29/14
RETIRED - Billing Reminder: Modifier Usage for Urological Supplies - Revised The Urological Supplies Local Coverage Determination (LCD) provides the use of modifiers with each submitted Healthcare Common Procedural Coding System (HCPCS) code. The use of the modifiers will indicate whether the applicable payment criteria are met (KX modifier), and provide information related to the coverage and/or liability (GA, GZ and GY modifiers) when the policy criteria are not met. 5/15/14
RETIRED - Correct Coding – Lithium Batteries The DME MACs have recently noted confusion on the part of DMEPOS suppliers regarding the proper billing of lithium batteries. 5/1/14
RETIRED - Medical Grade Honey as a Surgical Dressing Component – Request for Information Surgical Dressings are covered by the DME MACs when used on a qualifying wound. Medical grade honey has been a component in many dressings. Recently the DME MACs were called upon to evaluate the generally accepted medical uses of honey in wounds. 4/24/14
Home Oxygen Initial Qualification Testing - Dear Physician Letter Home use of oxygen and oxygen equipment is eligible for Medicare reimbursement only when beneficiary meets all of the requirements set out in the Oxygen and Oxygen Equipment Local Coverage Determination (LCD) and related Policy Article (PA). 4/24/14
CERT/Therapeutic Shoes for Persons with Diabetes - Dear Physician Letter Medicare covers therapeutic shoes and inserts for persons with diabetes as established by the Social Security Act Section 1861(s) (12). 4/24/14
ICD-10 Updates to LCDs and PAs To keep separate the ICD-9s from the ICD-10s, all ICD-10 LCDs and PAs (with and without diagnosis codes) have been assigned new ID numbers, and have an effective date of October 1, 2014. 4/10/14
Correct Coding and Coverage of Ventilators Ventilator technology has evolved to the point where it is possible to have a single device capable of operating in numerous modes, from basic continuous positive pressure (CPAP and bi-level PAP) to traditional pressure and volume ventilator modes. 4/3/14
RETIRED - Correct Coding - Definitions Used for Off-the-Shelf versus Custom Fitted Prefabricated Orthotics (Braces) - Revised As part of the January 2014 HCPCS update codes were created describing certain off-the-shelf (OTS) orthotics. Some of these OTS codes parallel codes for custom fitted versions of the same items. 3/27/14
LCD and Policy Article Revisions Summary for March 27, 2014 The principal changes to the policies for Ankle-Foot/Knee-Ankle-Foot Orthosis, Knee Orthoses, Oral Anticancer Drugs, Pneumatic Compression Devices and Spinal Orthoses: TLSO and LSO are outlined. 3/27/14
Changes to Local Coverage Determinations – ICD-10 Updates The DME MACs are providing notice that all ICD-10 LCDs and associated ICD-10 articles will be updated in the Medicare Coverage Database no later than 04/10/14. 3/20/14
Billing Reminder: Modifier Usage for Urological Supplies The Urological Supplies Local Coverage Determination (LCD) provides for the use of modifiers with each submitted HCPCS code to indicate whether the applicable payment criteria are met (KX modifier) and to provide other information related to coverage and/or liability (GA, GZ and GY modifiers) when the policy criteria are not met. 3/20/14
LCD and Policy Article Revisions Summary for March 20, 2014 The principal changes to the policies for Cervical Traction Devices, Lower Limb Prostheses, Oral Antiemetic Drugs, Power Mobility Devices, Group 1 Pressure Reducing Support Surfaces, Respiratory Assist Devices, Seat Lift Mechanisms, TENS, and Wheelchair are outlined. 3/20/14
RETIRED - Correct Coding - Billing of Powered L-Coded Items There are an increasing number of L-coded items, both orthotic and prosthetic components, which are electrically powered. Errors associated with correct coding these items have been identified in recent reviews. 3/20/14
LCD and Policy Article Revisions Summary for March 13, 2014 The principal changes to the policies for Glucose Monitors, High Frequency Chest Wall Oscillation Devices, Immunosuppressive Drugs, Nebulizers, Negative Pressure Wound Therapy Pumps, Orthopedic Footwear, Oxygen and Oxygen Equipment, PAP Devices for the Treatment of Obstructive Sleep Apnea and Wheelchair Options/Accessories are outlined. 3/13/14
LCD and Policy Article Revisions Summary for March 6, 2014 The principal changes to the policies for Automatic External Defibrillators, Hospital Beds and Accessories, Manual Wheelchair Bases, Mechanical In-exsufflation Devices, Osteogenesis Stimulators, Patient Lifts and Speech Generating Devices are outlined. 3/6/14
LCD and Policy Article Revisions Summary for February 27, 2014 The principal changes to the policies for External Infusion Pumps, Ostomy Supplies and Group 3 Pressure Reducing Support Surfaces is outlined. 2/27/14
Face-to-Face and Written Order Requirements for High Cost DME - Dear Physician Letter For certain specified items of durable medical equipment the Affordable Care Act requires that an in-person, face-to-face examination (F2F) documenting the need for the item must have occurred sometime during the six (6) months prior to the order for and delivery of the item. 2/21/14
Correct Coding - ApniCure Winx Sleep Therapy System The ApniCure, Inc. Winx® Sleep Therapy System uses continuous low suction delivered to the oral cavity via a fitted mouthpiece to move the soft tissue and increase the size of the airway in the retropharynx and oral cavity. 2/13/14
LCD and Policy Article Revisions Summary for February 13, 2014 The principal changes to the policy for Intravenous Immune Globulin and Suction Pumps is outlined. 2/13/14
Policy Article Revision Summary for January 30, 2014 The principal changes to the policy for Tracheostomy Care Supplies is outlined. 1/30/14
Coding Guideline - K0900 (Custom DME Equipment, Other than wheelchairs) A new HCPCS code, K0900, has been created for use with custom fabricated durable medical equipment other than wheelchairs. 1/23/14
Payment Rules - Continuous Passive Motion Machines - REVISED This article provides instructions and payment rules for continuous passive motions machines with revised standard written order language. 7/08/22
Breathe NIOV - Coding Reminder The NIOV System by Breathe Technologies, Inc. provides positive pressure inspiratory support for patient using oxygen. 1/16/14
Payment Rules Reminder - Home Oxygen Initial Qualification Testing Home use of oxygen and oxygen equipment is eligible for Medicare reimbursement only when the beneficiary meets all of the requirements set out in the Oxygen and Oxygen Equipment LCD and PA. 1/10/14
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