LCD and Policy Article Revisions Summary for July 23, 2020

Outlined below are the principal changes to the DME MAC Local Coverage Determination (LCD) and Policy Article (PA) that have been revised and posted. The policy included is External Infusion Pumps. Please review the entire LCD and related PA for complete information.

External Infusion Pumps

LCD

Revision Effective Date: 09/06/2020

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Revised: J7799 (Xembify) to J1558 for Dates of Service on or after 07/01/2020
Clarification: Coverage for Xembify effective for Dates of Service on or after 07/3/2019 (FDA Approval Date)
Added: Cutaquig to coverage criteria V(H) effective for Dates of Service on or after 12/12/2018 (FDA Approval Date)
Added: Statement regarding covered pumps for Cutaquig

SUMMARY OF EVIDENCE:
Added: Information related to Cutaquig

ANALYSIS OF EVIDENCE:
Added: Information related to Cutaquig

CODING INFORMATION:
Added: HCPCS code J1558 to Group 3 table

BIBLIOGRAPHY:
Added: Section related to Cutaquig

RELATED LOCAL COVERAGE DOCUMENTS:
Added: Response to Comments document A58288

PA

Revision Effective Date: 09/06/2020

MODIFIERS:
Added: J1558 and J7799 (Cutaquig) to the JB modifier requirements

CODING GUIDELINES:
Added: Billing instructions for Xembify based on DOS
Added: UOS billing instruction for J7799 (Cutaquig)

ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:
Added: J1558 and J7799 (Cutaquig) to the Group 3 paragraph

07/23/2020: 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 PAs. For complete information on any topic, you must review the LCDs and/or PAs.

With the update 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

 

            Last Updated Thu, 23 Jul 2020 15:05:14 +0000