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 External Infusion Pumps, Intravenous Immune Globulin, Nebulizers and Standard Documentation Requirements for All Claims Submitted to DME MACs. Please review the entire LCDs and related PAs for complete information.

External Infusion Pumps

LCD

Revision Effective Date: 04/01/2023
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Added: Instructions to DRUG WASTAGE section to see MODIFIERS section of LCD-related Policy Article (effective 01/01/2023)
Removed: JW and JZ modifier instructions from DRUG WASTAGE section (effective 01/01/2023)

06/15/2023: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates per CMS HCPCS coding determinations.

PA

Revision Effective Date: 04/01/2023
MODIFIERS:
Revised: JW and JZ modifier instructions to align with the CMS 2023 Physician Fee Schedule final rule (effective 01/01/2023)

06/15/2023: 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.

Intravenous Immune Globulin

LCD

Revision Effective Date: 01/01/2023
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Added: Instructions to DRUG WASTAGE section to see MODIFIERS section of the LCD-related Policy Article
Removed: JW and JZ modifier instructions from DRUG WASTAGE section

06/15/2023: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates per CMS HCPCS coding determinations.

PA

Revision Effective Date: 01/01/2023
MODIFIERS:
Revised: JW and JZ modifier instructions to align with the CMS 2023 Physician Fee Schedule final rule

06/15/2023: 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.

Nebulizers

LCD

Revision Effective Date: 01/01/2023
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Added: Instructions to DRUG WASTAGE section to see MODIFIERS section of the LCD-related Policy Article
Removed: JW and JZ modifier instructions from DRUG WASTAGE section

06/15/2023: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates per CMS HCPCS coding determinations.

PA

Revision Effective Date: 01/01/2023
MODIFIERS:
Revised: JW and JZ modifier instructions to align with the CMS 2023 Physician Fee Schedule final rule

06/15/2023: 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.

Standard Documentation Requirements for All Claims Submitted to DME MACs

PA

Revision Effective Date: 01/01/2023
ORDERS:
Revised: Reference to "1861(r)(1)" which refers to physicians by removing "(1)" to reflect the full statutory definition of treating practitioner
WRITTEN ORDERS PRIOR TO DELIVERY (WOPD):
Added: Statutory definition of treating practitioner for PMDs
FACE-TO-FACE ENCOUNTER:
Removed: "For example, the National Coverage Determination § 240.2 "Home use of Oxygen" requires a face-to-face examination within a month of starting home oxygen therapy." (effective 09/27/2021)

06/15/2023: 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