Article Detail - JA DME
LCD and Policy Article Revisions Summary for May 18, 2023
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 Enteral Nutrition, Osteogenesis Stimulators, Parenteral Nutrition and Seat Lift Mechanisms. Please review the entire LCDs and related PAs for complete information.
Enteral Nutrition
LCD
Revision Effective Date: 07/02/2023
SUMMARY OF EVIDENCE:
Added: Information related to GA, GY, GZ, and KX modifier addition
ANALYSIS OF EVIDENCE:
Added: Information related to GA, GY, GZ, and KX modifier addition
CODING INFORMATION:
Added: GA, GY, GZ, and KX modifiers
RELATED LOCAL COVERAGE DOCUMENTS:
Added: Response to Comments (A59397)
PA
Revision Effective Date: 07/02/2023
MODIFIERS:
Added: Section header
Added: BA, BO, GA, GY, GZ, and KX modifier instructions
Added: "As of January 1, 2023, suppliers must calculate the units of service (UOS) for each enteral product billed to Medicare, based on the treating practitioner’s order."
Added: "Claim lines billed with codes without a KX, GA, GY or GZ modifier will be rejected as missing information" for claims with dates of service on or after July 2, 2023
CODING GUIDELINES:
Removed: "As of January 1, 2023, suppliers must calculate the units of service (UOS) for each enteral product billed to Medicare, based on the treating practitioner’s order."
Removed: BA and BO modifier instructions
05/18/2023: 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.
Osteogenesis Stimulators
LCD
Revision Effective Date: 07/02/2023
SUMMARY OF EVIDENCE:
Added: Information related to GA, GZ, and KX modifier addition
ANALYSIS OF EVIDENCE:
Added: Information related to GA, GZ, and KX modifier addition
CODING INFORMATION:
Added: GA, GZ and KX modifiers
RELATED LOCAL COVERAGE DOCUMENTS:
Added: Response to Comments (A59402)
PA
Revision Effective Date: 07/02/2023
MODIFIERS:
Added: GA, GZ, KX modifier instructions
Added: "Claim lines billed with codes without a KX, GA or GZ modifier will be rejected as missing information" for claims with dates of service on or after July 2, 2023
05/18/2023: 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.
Parenteral Nutrition
LCD
Revision Effective Date: 07/02/2023
SUMMARY OF EVIDENCE:
Added: Information related to GA, GY, GZ, and KX modifier addition
ANALYSIS OF EVIDENCE:
Added: Information related to GA, GY, GZ, and KX modifier addition
CODING INFORMATION:
Added: GA, GY, GZ and KX modifiers
RELATED LOCAL COVERAGE DOCUMENTS:
Added: Response to Comments (A59399)
PA
Revision Effective Date: 07/02/2023
MODIFIERS:
Added: Section header
Added: BA, GA, GY, GZ, and KX modifier instructions
Added: "Claim lines billed with codes without a KX, GA, GY or GZ modifier will be rejected as missing information" for claims with dates of service on or after July 2, 2023
CODING GUIDELINES:
Removed: BA modifier instructions
05/18/2023: 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.
Seat Lift Mechanisms
LCD
Revision Effective Date: 07/02/2023
SUMMARY OF EVIDENCE:
Added: Information related to GA, GZ, and KX modifier addition
ANALYSIS OF EVIDENCE:
Added: Information related to GA, GZ, and KX modifier addition
CODING INFORMATION:
Added: GA, GZ and KX modifiers
RELATED LOCAL COVERAGE DOCUMENTS:
Added: Response to Comments (A59403)
PA
Revision Effective Date: 07/02/2023
MODIFIERS:
Added: Section header
Added: GA, GZ, KX modifier instructions
Added: "Claim lines billed with codes without a KX, GA or GZ modifier will be rejected as missing information" for claims with dates of service on or after July 2, 2023
05/18/2023: 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.
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:
- Open the currently effective policy on the Medical Coverage Database (MCD)
- Links to the MCD can be found on the Active LCDs page on the Noridian website
- 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
- There are direct links to all LCDs under the 'LCD ID number and Effective Date' column
- Links to the MCD can be found on the Active LCDs page on the Noridian website
- Scroll down to the bottom of the policy
- Find the section labeled Public Version(s)
- Look for the link to the policy that was effective on the dates of service in question
- Click on hyperlink to go to the policy
