Article Detail - JA DME

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 Infusions Pumps

LCD

Revision Effective Date: 07/01/2022
HCPCS CODES:
Added: J1551 to group 3 codes, effective for billing on or after July 1, 2022

07/28/2022: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates to CMS HCPCS coding determinations.

PA

Revision Effective Date: 07/01/2022
MODIFIERS:
Revised: J7799 (Cutaquig) to HCPCS code J1551 in JB modifier requirements
CODING GUIDELINES:
Revised: Billing direction dates for Cutaquig under HCPCS code J7799
Added: Billing direction for Cutaquig for HCPCS Code J1551, effective on or after July 1, 2022
Revised: specific SCIg preparations table to list HCPCS J1551, instead of J7799 (Cutaquig)
CODING INFORMATION:
Revised: Cutaquig HCPCS code to J1551 under Group 3

07/28/2022: At this time the 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