LCD and Policy Article Revisions Summary for December 29 2016 - JD DME

Posted December 29, 2016

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 External Infusion Pumps and Intravenous Immune Globulin.  Please review the entire LCD and related PA for complete information.

External Infusion Pumps

LCD

Revision Effective Date: 01/01/2017

COVERAGE INDICATIONS, INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

Added: Denial verbiage for JW Modifier when coverage criteria not met

HCPCS MODIFIERS:

Added: JW Modifier

DOCUMENTATION REQUIREMENTS:

Added: JW Modifier instructions

Policy Article

Revision Effective Date: 07/01/2016

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

Revised: Language regarding payment rules for infusion drugs started in a physician's office or hospital outpatient department. – Effective 4/25/2016

Intravenous Immune Globulin

LCD

Revision Effective Date: 01/01/2017

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

Added: Denial language for JW Modifier when coverage criteria not met

HCPCS MODIFIERS:

Added: JW Modifier

DOCUMENTATION REQUIREMENTS:

Added: JW Modifier instructions 

Note: The information contained in this article is only a summary of revisions to the LCDs and Policy Articles.  For complete information on any topic, you must review the LCDs and/or Policy Articles.