LCD and Policy Article Revisions Summary for June 25, 2020

Outlined below are the principal changes to the DME MAC Local Coverage Determination (LCD) and Policy Articles (PAs) that have been revised and posted. The policies included are Lower Limb Prostheses and Surgical Dressings. Please review the entire LCDs and related PAs for complete information.

Lower Limb Prostheses

PA

Revision Effective Date: 08/01/2020
CODING GUIDELINES:
Added: Coding guidelines for HCPCS codes L5856, L5857, L5858, L5980, L5981, and L5987

CODING VERIFICATION REVIEW:
Added: Section header for information related to PDAC coding verification review
Revised: PDAC coding verification review information for HCPCS code L5969, to include effective for DOS on or after 01/01/2014
Added: PDAC coding verification review information for HCPCS codes L5856, L5857, L5858, L5973, L5980, and L5987, effective for DOS on or after 01/01/2021

06/25/2020: 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.

Surgical Dressings

LCD

Revision Effective Date: 01/01/2020
CPT/HCPCS CODES:
Corrected: Descriptor for the A9 modifier to include “or more” in Group 1 Paragraph

06/25/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-substantive corrections.

PA

Revision Effective Date: 01/01/2020
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Revised: Included descriptor of the A9 modifier

06/25/2020: 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 Wed, 24 Jun 2020 13:34:28 +0000