LCD and Policy Article Revisions Summary for June 18, 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 Oxygen and Oxygen Equipment. Please review the entire LCD and related PA for complete information.

Oxygen and Oxygen Equipment

LCD

Revision Effective Date: 08/02/2020

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Revised: "physicians" to "treating practitioners
Removed: Statement to refer to ICD-10 Codes that are Covered section in the LCD-related PA
Added: Statement to refer to ICD-10 codes in the LCD-related Policy Article

GENERAL:
Revised: Order information as a result of Final Rule 1713

SUMMARY OF EVIDENCE:
Added: Information related to topical oxygen

ANALYSIS OF EVIDENCE:
Added: Information related to topical oxygen

CODING INFORMATION:
Removed: Field titled “Bill Type”
Removed: Field titled “Revenue Codes”
Removed: Field titled “ICD-10 Codes that Support Medical Necessity”
Removed: Field titled “ICD-10 Codes that DO NOT Support Medical Necessity”
Removed: Field titled “Additional ICD-10 Information”

GENERAL DOCUMENTATION REQUIREMENTS:
Revised: Prescriptions (orders) to SWO

BIBLIOGRAPHY:
Added: Section related to topical oxygen

RELATED LOCAL COVERAGE DOCUMENTS:
Added: Response to Comments (A58247)

PA

Revision Effective Date: 08/02/2020

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Revised: “physician” to “treating practitioner”

REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PERSUANT TO 42 CFR 410.38(g):
Removed: Section removed

REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 Fed. Reg Vol 217):
Added: Section and related information based on Final Rule 1713

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Revised: “physician” to “treating practitioner”

CERTIFICATE OF MEDICAL NECESSITY (CMN):
Revised: “physician” to “treating practitioner”
Revised: “detailed written order” to “standard written order”
Removed: Outdated CMN Form number

ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:
Revised: Section header “ICD-10 Codes that are Covered” updated to “ICD-10 Codes that Support Medical Necessity”

ICD-10 CODES THAT DO NOT SUPPORT MEDICAL NECESSITY:
Revised: Section header “ICD-10 Codes that are Not Covered” updated to “ICD-10 Codes that DO NOT Support Medical Necessity”

06/18/2020: 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, 18 Jun 2020 13:45:30 +0000