Article Detail - JA DME

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 and Wheelchair Options/Accessories. Please review the entire LCDs and related PAs for complete information.

Power Mobility Devices

LCD

Revision Effective Date: 05/16/2023
CMS NATIONAL COVERAGE POLICY:
Added: "280.16"
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Revised: "Wheelchair Options and Accessories" to "Wheelchair Options/Accessories"
Removed: "Refer to the related Policy Article for information concerning coverage of Group 2 PWCs with seat elevators (K0830, K0831). "

08/17/2023: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates due to development of National Coverage Determination (NCD) 280.16.

PA

Revision Effective Date: 05/16/2023
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Removed: "A seat elevator is a statutorily noncovered option on a power wheelchair. If a PWC with a seat elevator (K0830, K0831) is provided, it will be denied as non-covered. "
CODING GUIDELINES:
Revised: "Wheelchair Options and Accessories" to "Wheelchair Options/Accessories"

08/17/2023: 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: 05/16/2023
CMS NATIONAL COVERAGE POLICY:
Added: "280.16"
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Added: Coverage information for the power seat elevation system (E2300) when the beneficiary meets coverage criteria for either a Group 2 single power option or multiple power option power-driven wheelchair, or a Group 3 power-driven wheelchair and meets the coverage criteria for seat elevation equipment as described in the National Coverage Determination (NCD) 280.16.

08/17/2023: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates due to development of National Coverage Determination (NCD) 280.16.

PA

Revision Effective Date: 05/16/2023
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Revised: "POWER SEATING SYSTEMS" to "POWER STANDING SYSTEM"
Removed: Language that specified a power seat elevation feature (E2300) is non-covered

08/17/2023: 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:

1. Open the currently effective policy on the Medical Coverage Database (MCD)
   1. Links to the MCD can be found on the Active LCDs page on the Noridian website
      1. 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
      2. There are direct links to all LCDs under the ‘LCD ID number and Effective Date’ column
2. Scroll down to the bottom of the policy
3. Find the section labeled Public Version(s)
4. Look for the link to the policy that was effective on the dates of service in question.
5. Click on hyperlink to go to the policy.