Medical Director Articles - 2015

 
Title Brief Description Last Updated
LCD and Policy Article Revisions Summary for December 17, 2015 The principal changes to the polices for Nebulizers and Pneumatic Compression Devices are outlined. 12/17/15
RETIRED - Coverage and Coding - New Oral Antiemetic Drug Akynzeo - Revised This is a revision to previous version (with the same title), published May 28, 2015, and adds the new HCPCS code for Akynzeo. 12/17/15
Correct Coding - Face Down Positioning Devices This article was originally published in 2003 and is being republished as a reminder to suppliers on the correct coding and coverage of these devices. 12/17/15
RETIRED - Correct Coding - Ankle Orthoses, With or Without Joints, Prefabricated or Custom Fabricated Coding Verification Review The Centers for Medicare & Medicaid Services HCPCS Workgroup released HCPCS codes effective January 1, 2016. 12/3/15
Correct Coding - 2015 HCPCS Code Annual Update The following tables identify changes to Level II HCPCS codes for 2016. 12/3/15
LCD and Policy Article Revisions Summary for December 3, 2015 The principal changes to the policy for Wheelchair Seating is outlined. 12/3/15
Coverage and Coding - New Oral Antiemetic Drug Varubi The U.S. Food and Drug Administration approved Varubi (rolapitant) on September 2, 2015. 11/19/15
Correct Coding - Tracheostomy Tubes Proper coding of "customized" tracheostomy tubes is described. 11/12/15
RETIRED - Speech Generating Devices - Coding Verification Review Requirements All products currently listed on the Pricing, Data Analysis, and Coding (PDAC) contractor website with HCPCS code E2510 will be end dated effective May 31, 2016. 11/5/15
Lower Limb Prostheses - Draft Policy DL33787 On November 02, 2015, CMS announced the convening of an inter-agency panel to address clinical questions associated with the provision of lower limb prostheses. 11/5/15
Correct Coding - Buzzy The Buzzy (MMJ Labs), a palm-sized vibrating bee with a removable ice pack and center slot for an optional tourniquet, must be billed to the DME MAC using HCPCS code A9270 and will be denied as statutorily non-covered. 11/5/15
Correct Coding - TOBI Podhaler The TOBI Podhaler™ (Novartis) is a disposable, hand-held medication dispenser used for the inhalation of tobramycin; however, it is not eligible for reimbursement under Medicare DME. 10/29/15
LCD and Policy Article Revisions Summary for October 22, 2015 The principal changes to policy for Speech Generating Devices is outlined. 10/22/15
Correct Coding - Diathermy and Biofeedback Devices HCPCS coding verification reviews have been received for both diathermy and biofeedback devices used as part of inpatient or outpatient facility therapy but that are subsequently given to the beneficiary for use in the home; however, these items do not meet the payment requirements to be reimbursed as DME. 10/22/15
Correct Coding - P-Stim Device Claims submitted to the DME MACs for the P-stim device must be coded as A9270 and are not reimbursable by Medicare. 10/22/15
Updated External Infusion Pump Policy - Parenteral Inotropic Therapy FAQs View questions and answers on the updated External Infusion Pump policy. 10/15/15
RETIRED - Response to Comment to Accompany LCD for Pneumatic Compression Devices View DME Medical Director responses to comments regarding the Pneumatic Compression Devices policy. 10/15/15
RETIRED - LCD and Policy Article Summary for October 15, 2015 - Drafts Released to Final The Draft Pneumatic Compression Devices Local Coverage Determination and Policy Article has been finalized with effective date December 1, 2015. 10/15/15
RETIRED - Billing Instructions - Completing External Infusion Pump LCD DIF for Levodopa-Carbidopa Enteral Suspension For claims with an initial date of service on or after November 15, 2015, suppliers must submit an initial DIF in accordance with the instructions included in this article. 10/15/15
LCD and Policy Article Revisions Summary for October 8, 2015 The principal changes to the policies for Orthopedic Footwear, Osteogenesis Stimulators and Wheelchair Seating are outlined. 10/8/15
Osteogenesis Stimulator Policy Revision FAQs Questions and answers regarding the Osteogenesis Stimulator policy revision are provided. 10/8/15
Dear Physician Letter - Face-to-Face and Written Order Requirements for High Cost DME This letter to physicians provides additional guidance for the Affordable Care Act requirements. 10/1/15
Dear Physician Letter - ICD-10 The DME Medical Directors have provided a letter that suppliers may use to remind physicians of the ICD-10 requirement, beginning October 1, 2015. 9/24/15
RETIRED - PROSE Device - Correct Coding This article discusses the correct coding of the PROSE device, which are devices designed to rest on the sclera or white part of the eye and are used to treat ocular surfaces diseases, including some types of "dry eye". 9/3/15
Updated Glucose Monitors and Supplies Physician Letter [PDF] The Glucose Monitors and Supplies letter to physicians has been updated. 9/3/15
LCD and Policy Article Revisions Summary for August 20, 2015 Principal changes to the policy for Commodes is outlined. 8/20/15
RETIRED - Correct Coding - Surgical Dressings Containing Unclassified Materials Some multi-component surgical dressings contain materials for which no specific HCPCS code exists. This article reviews the coding guidelines for these items. 8/13/15
RETIRED - Parenteral Nutrition CERT Errors - Documentation Reminder An examination of CERT reviews for parenteral nutrition claims has identified common errors in the information submitted in support of claims payment. This article will review the findings and related policy requirements. 8/6/15
Public Comment Notice - Surgical Dressings Draft Policy The Surgical Dressings Draft Policy has been released for comment. 8/6/15
RETIRED - Lower Limb Prosthesis Draft LCD Bibliography The bibliography for this draft was inadvertently omitted during the publication process. 8/3/15
PDAC Code Review - E0740 Non-Implantable Pelvic Floor Electrical Stimulator Based upon the code narrative, code history including the predicate products, and creation of National Coverage Determination 230.8, the PDAC concluded that HCPCS code E0740 is intended to describe non-implantable pelvic floor electrical stimulators with integrated monitoring capabilities. 7/30/15
LCD and Policy Article Revisions Summary for July 23, 2015 The principal changes to the policy for Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) is outlined. 7/23/15
Draft Policies Release for Comment Bulletin Article The DME MACs are proposing two revised LCDs and one new LCD. These LCDs require a 45-day public comment period. 7/16/15
RETIRED - Correct Coding - Definitions Used for Off-the-Shelf versus Custom Fitted Prefabricated Orthotics (Braces) - Correction As part of the 2014 and 2015 HCPCS update, codes were created describing certain off-the-shelf (OTS) orthotics.  Some of these codes parallel codes for custom fitted versions of the same items. 7/2/15
LCD and Policy Article Revisions Summary for June 11, 2015 - Revised The principal changes to the policies for  Facial Prosthesis, Ostomy Supplies, Tracheostomy Care Supplies and Urological Supplies are outlined. 6/25/15
RETIRED - DIFs Usage for Enteral and Parenteral Nutrition and External Infusion Pumps - Revised This article was originally published in January 2015 and is revised to reflect that external infusion pumps do not require a recertification DIF when the length of need expires and the ordering physician extends the length of need. 6/11/15
Correct Coding - Modifiers AU, AV and AW Effective for dates of service on or after August 1, 2015, claims submitted without the appropriate modifier will be rejected as missing information. 6/11/15
LCD and Policy Article Revisions Summary for May 21, 2015 The principal changes to the policies for Speech Generating Devices, Transcutaneous Electrical Joint Stimulation Devices (TEJSD), Transcutaneous Electrical Nerve Stimulators (TENS) and Vacuum Erection Devices (VED). 5/21/15
RETIRED - Correct Coding - Urinary "No-Touch" Catheters Urinary "no-touch" catheter systems are designed to perform urinary catheterization without the need to directly touch the catheter during insertion. 5/21/15
RETIRED - Correct Coding - LIM Innovations Infinite Socket This is a revision to the original article, posted May 21, 2015. This article changes the previously published benefit determination and code assignment. 5/21/15
RETIRED - Vacuum Erection Devices - Non-Covered by Medicare The Achieving a Better Life Experience (ABLE) Act of 2014 eliminated Medicare coverage for vacuum erection devices (VED). Consequently, claims billed to Medicare for codes L7900 and L7902 for dates of service on or after July 1, 2015 will be denied as non-covered (no benefit). 5/21/15
LCD and Policy Article Revisions Summary for May 14, 2015 The principal changes to the policies for Glucose Monitors, Pneumatic Compression Devices, Respiratory Assist Devices, Wheelchair Options/Accessories and Wheelchair Seating are outlined. 5/14/15
RETIRED - Correct Coding - WHILL Model A Powered Personal Mobility Device The WHILL Model A (Whill, Inc., San Carlos, CA) is a powered personal mobility device designed to improve the mobility for all, not just those with a disability. 5/14/15
Correct Coding - Weightless Walkers The Weightless Walker (Weightless Walker, Inc.) is an enclosed, wheeled walker with a seat. 5/14/15
RETIRED - Correct Coding - BEMER Physical Vascular Therapy Devices BEMER Physical Vascular Therapy Devices provides broad spectrum, low intensity, pulsed, electromagnetic therapy which the manufacturer claims is effective for various conditions. 5/14/15
LCD and Policy Article Revisions Summary for May 7, 2015 The principal changes to the policies for Automatic External Defibrillators, Enteral Nutrition, External Breast Prostheses, Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics), and Parenteral Nutrition are outlined. 5/7/15
LCD and Policy Article Revisions Summary for April 30, 2015 The principal changes to the policies for Ankle-Foot/Knee-Ankle-Foot Orthoses, Knee Orthoses, Spinal Orthoses: TLSO and LSO and Suction Pumps are outlined. 4/30/15
LCD and Policy Article Revisions Summary for April 23, 2015 The principal changes to the policies for Pressure Reducing Support Surfaces - Groups 2 and 3, Seat Lift Mechanisms and Therapeutic Shoes for Persons with Diabetes are outlined. 4/23/15
LCD and Policy Article Revisions Summary for April 16, 2015 The principal changes to the policies for Eye Prostheses, Oxygen and Oxygen Equipment, Pressure Reducing Support Surfaces - Group 1 and Walkers are outlined. 4/16/15
LCD and Policy Article Revisions Summary for April 9, 2015 The principal changes to the policies for Orthopedic Footwear, Patient Lifts and Vacuum Erection Devices are outlined. 4/9/15
LCD and Policy Article Revisions Summary for April 2, 2015 The principal changes to the policies for Commodes, Immunosuppressive Drugs, Intrapulmonary Percussive Ventilation System, Oral Appliances for Obstructive Sleep Apnea and Osteogenesis Stimulators are outlined. 4/2/15
RETIRED - Blinatumomab (Blincyto) - Billing Instructions Medicare encourages physicians, hospitals, other providers and suppliers to administer medication to patients in such a way that they use the drugs most efficiently, and in a clinically appropriate manner. 3/26/15
LCD and Policy Article Revisions Summary for March 26, 2015 The principal changes to the policies for Canes and Crutches, Cold Therapy, External Infusion Pumps, Infrared Heating Pad System and Manual Wheelchair Bases are outlined. 3/26/15
LCD and Policy Article Revisions Summary for March 19, 2015 The principal changes to the policies for Heating Pads and Heat Lamps and High Frequency Chest Wall Oscillation Devices are outlined. 3/19/15
LCD and Policy Article Revisions Summary for March 12, 2015 The principal changes to the policies for Negative Pressure Wound Therapy Pumps and PAP Devices for the Treatment of Obstructive Sleep Apnea are outlined. 3/12/15
LCD and Policy Article Revisions Summary for March 5, 2015 The principal changes to the policies for Cervical Traction Devices, Hospital Beds and Accessories, Intravenous ImmuneGlobulin and Mechanical In-exsufflation Devices are outlined. 3/5/15
LCD and Policy Article Revisions Summary for February 26, 2015 The principal changes to the policies for Lower Limb Prostheses, Power Mobility Devices and Refractive Lenses are outlined. 2/26/15
LCD and Policy Article Revisions Summary for February 19, 2015 The principal changes to the policies for External Fusion Pumps are outlined. 2/19/15
RETIRED - Coverage Reminder - Osteogenesis Stimulators An examination of CERT reviews for osteogenesis stimulator claims has identified common errors in the information submitted in support of claims payment. 2/12/15
RETIRED - Correct Billing of Non-Invasive Interfaces Used in Conjunction with HCPCS Code E0472 Claim reviews have shown that suppliers are billing HCPCS code E0472 with non-invasive interfaces. 2/12/15
RETIRED - Correct Coding and Coverage - Peristeen Transanal Irrigation System The Peristeen transanal irrigation system is a device used to empty the lower bowel and to prevent chronic constipation and fecal incontinence or simply as a method of bowel management. 2/12/15
Modifier Requirements Due to Lack of a Physician's Order - Modifier EY Noridian has received inquiries regarding the proper submission of modifiers EY, GY and GA when a denial is anticipated due to the lack of a prescription. 2/12/15
Correct Coding - Cast Covers  The DME MACs have received inquiries about coverage of covers for casts. These are typically constructed of latex or rubber and are designed to fit over a cast to allow bathing, showering or swimming without water infiltration. 1/15/15
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