LCD and Policy Article Revisions Summary for March 27 2014 - JD DME

Outlined below are the principal changes to DME MAC Local Coverage Determinations (LCDs) and a Policy Articles (PA) 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: 01/01/2014

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

Added:  References to off-the-shelf (OTS) and custom fitted

Added: New and revised 2014 HCPCS codes to coverage statements

Revised: Specific ICD-9 diagnosis codes contained in the narrative are replaced with a reference to the applicable diagnosis code tables

HCPCS CODES AND MODIFIERS:

Added: L4361, L4387, L4397

For the following codes, the descriptor was changed: L1902, L1904, L1906, L1907, L4350, L4360, L4370, L4386, L4396, L4398
DOCUMENTATION REQUIREMENTS:

Added:  Documentation requirement for custom fitted vs. OTS

Policy Article:

Revision Effective Date: 01/01/2014

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added:  Correct coding statement for prefabricated orthoses

Added: Denial statement for incorrect coding

CODING GUIDELINES:

Added:  Definitions of off-the-shelf and custom fitted

Added:  Respective off-the-shelf and custom fitted codes to coding statements

Added: Definitions for minimal self-adjustment, substantial modification and kits

Knee Orthoses

LCD

Revision Effective Date: 01/01/2014
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

Added:  References to off-the-shelf (OTS) and custom fitted

Added:  HCPCS codes for OTS and custom fitted to their respective coverage statements, including correct coding statement for custom fitted items

Added: HCPCS codes to the Tables for Addition Codes-Eligible for Separate Payment, and Not Reasonable and Necessary

Revised: Specific ICD-9 diagnosis codes contained in the narrative are replaced with a reference to the applicable diagnosis code tables

HCPCS CODES AND MODIFIERS:
Added: L1812, L1833, L1848

For the following codes, the descriptor was changed: L1810, L1830, L1832, L1836, L1843, L1845, L1847, L1850

DOCUMENTATION REQUIREMENTS:

Added:  Documentation requirement for custom fitted vs. OTS

Policy Article

Revision Effective Date: 01/01/2014

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added:  Correct coding statement for prefabricated orthoses

Added: Denial statement for incorrect coding

Added: L1812 and L1833 to the reasonable useful lifetime table
CODING GUIDELINES:
Added: Definitions for off-the-shelf and custom fitted

Added: Definitions for minimal self-adjustment, substantial modification and kits

Added: L1812, L1833, L1848 base codes and the not separately payable codes to the table

Oral Anticancer Drugs

Policy Article

Revision Effective Date: 03/01/2014

ICD-9 CODES THAT ARE COVERED:

Deleted:  ICD-9 diagnosis code V23.89. Inadvertent addition of an inappropriate ICD-9-CM code             

Pneumatic Compression Devices

LCD

Revision Effective Date: 11/01/2013 (March 2014 Publication)

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

Added: Information that item(s) in policy are subject to ACA 6407 requirements (effective 07/01/2013)

POLICY SPECIFIC DOCUMENTATION

REQUIREMENTS:

Added: ACA 6407 information (requirements effective 07/01/2013)

Policy Article

Revision Effective Date: 11/01/2013 (March 2014 Publication)

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: ACA 6407 information (requirements effective 07/01/2013)

Spinal Orthoses: TLSO and LSO LCD

Revision Effective Date: 01/01/2014

COVERAGE INDICATIONS, LIMITATIONS, and/or MEDICAL NECESSITY:

Added: References to off-the-shelf (OTS) and custom fitted

Added: HCPCS codes for OTS and custom fitted to their respective coverage statements, including correct coding statement for custom fitted items

HCPCS CODES AND MODIFIERS:

Added: L0455, L0457, L0467, L0469, L0623, L0641, L0642, L0643, L0648, L0649, L0650 and L0651

Revised: HCPCS Narrative of L0450, L0454, L0456, L0460, L0466, L0468, L0621, L0625, L0626, L0627, L0628, L0630, L0631, L0633, L0637, L0639 and L0984

DOCUMENTATION REQUIREMENTS:

Added: Documentation requirement for custom fitted vs. OTS

Policy Article

Revision Effective Date: 01/01/2014

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

Added: Correct coding statement for prefabricated orthoses

CODING GUIDELINES:

Added: Definitions for off-the-shelf and custom fitted

Added: Definitions for minimal self-adjustment, substantial modification and kits

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.