LCD and Policy Article Revisions Summary for October 30, 2025 - JD DME
LCD and Policy Article Revisions Summary for October 30, 2025
Joint DME MAC Publication
Posted October 30, 2025
Outlined below are the principal changes to the DME MAC Local Coverage Determinations (LCDs) and Policy Articles (PAs) that have been revised and posted. The policies included are Power Mobility Devices, Respiratory Assist Devices, Speech Generating Devices (SGD), Walkers, and Wheelchair Options/Accessories. Please review the entire LCDs and PAs for complete information.
Power Mobility Devices
LCD
Revision Effective Date: 10/01/2025
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Revised: Language pertaining to HCPCS code E0986, by revising "push-rim activated power assist device (E0986)" to "power assist system (E0986)"
HCPCS CODES:
Revised: Long description of HCPCS code E0986
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Revised: "push-rim activated power assist device" to "power assist system" in language that pertains to a specialty evaluation
Revised: "push-rim activated power assist" to "power assist system" in language that pertains to a specialty evaluation
10/30/2025: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates per CMS HCPCS coding determinations and non-substantive to align with the HCPCS long description.
PA
Revision Effective Date: 10/01/2025
POLICY SPECIFIC DOCUMENTATION:
Revised: "push-rim activated power assist" to "power assist system" in language that pertains to a specialty evaluation
MODIFIERS:
Revised: "If the power mobility device or push-rim activated power assist device that is provided is only needed for mobility outside the home, the GY modifier must be added to the codes for the item and all accessories." to "If the power mobility device or power assist system that is provided is only needed for mobility outside the home, the GY modifier must be added to the codes for the item and all accessories."
CODING GUIDELINES:
Revised: Information pertaining to Non-expandable Controller definition, by revising "power seating actuators through the drive control" to "power actuators" and by revising "power seating actuators though" to "power actuators through"
Revised: Information pertaining to Expandable Controller definition, by revising "powered seating actuators through the drive control" to "powered actuators," by adding examples of powered actuators, by revising "power seating actuators though" to "power actuators through," and by removing "E2310 or" from the reference of an additional component required when control of the power actuators is through the Control Input Device
Added: "Power seat elevation" to the motors referenced as those that E2310 and E2311 allow the patient to control from a single interface
Revised: "captains chair" to "captain’s chair"
Revised: "Captains chair" to "Captain’s chair"
Revised: "Push-rim activated power assist (E0986)" to "Power assist system (E0986)" and the information pertaining to the definition of the power assist system
Added: "Power add-on" and definition information
Revised: "captains chairs" to "captain’s chairs"
10/30/2025: 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.
Respiratory Assist Devices
LCD
Revision Effective Date: 06/09/2025
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Revised: "INITIAL COVERAGE CRITERIA FOR E0470 AND E0471 DEVICES FOR THE FIRST THREE MONTHS OF THERAPY" to "INITIAL COVERAGE CRITERIA FOR E0470 AND E0471 DEVICES"
10/30/2025: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates due to NCD 240.9 Noninvasive Positive Pressure Ventilation (NIPPV) in the Home for the Treatment of Chronic Respiratory Failure (CRF) Consequent to Chronic Obstructive Pulmonary Disease (COPD).
Speech Generating Devices (SGD)
LCD
Revision Effective Date: 10/01/2024
HCPCS CODES:
Added: HCPCS code A4601 to Group 1 Codes
10/30/2025: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates.
Walkers
PA
Revision Effective Date: 10/01/2025
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: "A combination wheeled walker with seat and transport chair (E0150) is noncovered as it does not meet the definition of DME."
10/30/2025: 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.
Wheelchair Options/Accessories
LCD
Revision Effective Date: 10/01/2025
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Revised: "For information concerning a push-rim activated power assist device for a manual wheelchair, refer to the Power Mobility Devices medical policy." to "For information concerning a power assist system for a manual wheelchair, refer to the Power Mobility Devices medical policy."
10/30/2025: Pursuant to the 21st Century Cures Act, this revision does not require notice and comment because the revision is non-substantive to align with information in the Power Mobility Devices medical policy.
PA
Revision Effective Date: 10/01/2025
CODING GUIDELINES:
Revised: "For information concerning a push-rim activated power assist device for a manual wheelchair, refer to the Power Mobility Devices medical policy." to "For information concerning a power assist system for a manual wheelchair, refer to the Power Mobility Devices medical policy."
Revised: Information pertaining to non-expandable controller, by revising "power seating actuators through the drive control" to "power actuators" and by revising "power seating actuators though" to "power actuators through"
Revised: Information pertaining to expandable controller, by revising "powered seating actuators through the drive control" to "powered actuators," by adding examples of powered actuators, by revising "power seating actuators though" to "power actuators through," and by removing "E2310 or" from the reference of an additional component required when control of the power actuators is through the Control Input Device
10/30/2025: 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/or 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:
- Open the currently effective policy on the Medical Coverage Database (MCD)
- Links to the MCD can be found on the Active LCDs page on the Noridian website
- 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
- There are direct links to all LCDs under the ‘LCD ID number and Effective Date’ column
- Links to the MCD can be found on the Active LCDs page on the Noridian website
- Scroll down to the bottom of the policy
- Find the section labeled Public Version(s)
- 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.
