LCD and Policy Article Revisions Summary for October 15, 2020

Posted October 15, 2020

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 Refractive Lenses, Surgical Dressings, and Urological Supplies. Please review the entire LCDs and related PAs for complete information.

Refractive Lenses

LCD

Revision Effective Date: 10/01/2020
HCPCS CODES:
Added: HCPCS Code V2524 to Group 3 codes (effective for DOS on or after October 1, 2020)

10/15/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates to add CMS HCPCS coding determinations.

PA

Revision Effective Date: 10/01/2020
CODING GUIDELINES:
Added: Guideline information for HCPCS code V2524

10/15/2020: 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

PA

Revision Effective Date: 01/01/2020
QUALIFYING DRESSING REQUIREMENTS:
Revised: Indication that eligible products “include both” to “are defined as”
Revised: Eligible product information, to include definitions of primary and secondary dressings

CODING GUIDELINES:
Added: Coding guidelines for Alginate or Other Fiber Gelling Dressings (A6196, A6197, A6198)
Revised: Clarified wound fillers as primary dressings
Revised: Clarified wound covers as primary or secondary dressings
Added: Clarification regarding sizing related to adhesive borders

10/15/2020: 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.

Urological Supplies

LCD

Revision Effective Date: 10/01/2020
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Removed: HCPCS A4335 from inFlow device reference due to new HCPCS codes as of 10/01/2020

HCPCS CODES:
Added: K1010, K1011 and K1012 (effective DOS on or after 10/01/2020)

10/15/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates to add CMS HCPCS coding determinations.

PA

Revision Effective Date: 10/01/2020
MODIFIERS:
Removed: inFlow A4335 code from directions

CODING GUIDELINES:
Revised: inFlow HCPCS billing direction, HCPCS A4335 for DOS 07/26/2020 through 9/30/2020 and HCPCS K1010, K1011 and/or K1012 for DOS on or after 10/01/2020
Added: Billing direction for K1010, K1011 and K1012

10/15/2020: 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, 15 Oct 2020 13:05:39 +0000