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 High Frequency Chest Wall Oscillation Devices, Mechanical In-exsufflation Devices, Oral Anticancer Drugs, Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics), Transcutaneous Electrical Nerve Stimulators (TENS) and Wheelchair Seating. Please review the entire LCDs and related PAs for complete information.

High Frequency Chest Wall Oscillation Devices

PA

Revision Effective Date: 10/01/2021
ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY:
Revised: ICD-10-CM code G71.20 and M35.03 descriptions in Group 1 Codes, due to annual ICD-10-CM code updates

10/07/2021: 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.

Mechanical In-exsufflation Devices

PA

Revision Effective Date: 10/01/2021
ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY:
Revised: ICD-10-CM code description for G71.20 due to annual ICD-10-CM Code updates

10/07/2021: 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.

Oral Anticancer Drugs

PA

Revision Effective Date: 10/01/2021
ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY:
Added: ICD-10-CM C56.3 to groups 1, 2, 3, 4, 6, 7, 9, ICD-10-CM C79.63 to groups 2, 3, 4, 6, 7, 8, 9, ICD-10-CM C84.7A to groups 1, 3, 4, 5, 7 due to annual ICD-10-CM code updates

10/07/2021: 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.

Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics)

PA

Revision Effective Date: 10/01/2021
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Removed: “multiple codes” after “netupitant/palonosetron” and replaced with J8655
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Removed: References of “Q0181” and “depending on date of service” after palonosetron and netupitant/palonosetron
Added: Instructions for billing Q0181
CODING GUIDELINES:
Added: Directions for billing rolapitant based on multiple codes for the appropriate date of service
ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY:
Added: ICD-10-CM C56.3, C79.63 and C84.7A to Group 1 due to annual ICD-10-CM code updates

10/07/2021: 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.

Transcutaneous Electrical Nerve Stimulators (TENS)

LCD

Revision Effective Date: 11/20/2021
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Removed: Criterion III Chronic Lower Back Pain (CLBP) due to coverage expired June 7, 2015 under NCD 160.27
Added: Not reasonable and necessary statement in accordance with NCD 160.27
CODING INFORMATION:
Removed: Modifier Q0 under HCPCS Modifiers section
APPENDICES:
Removed: CLBP clinical trial references

10/7/2021: In accordance with NCD 160.27, coverage of TENS for CLBP is no longer available under Coverage with Evidence Development. Per the NCD, TENS is not reasonable and necessary for the treatment of CLBP under section 1862(a)(1)(A) of the Act. As a result, the DME MACs are removing this requirement as a non-discretionary change to the LCD, per the Program Integrity Manual, Chapter 13, §13.2.4.

PA

Revision Effective Date: 11/20/2021
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Revised: Language regarding supply allowances during the rental period for clarification
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Removed: Medical records statement for Criterion III as coverage expired June 7, 2015 for CLBP under NCD 160.27
MODIFIERS:
Removed: Q0 modifier statements regarding Criterion III as coverage expired June 7, 2015 for CLBP under NCD 160.27
ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY:
Removed: ICD-10-CM codes used for CLBP as coverage expired June 7, 2015 for CLBP under NCD 160.27
ICD-10-CM CODES THAT DO NOT SUPPORT MEDICAL NECESSITY:
Removed: Statement under paragraph 1 regarding CLBP and all codes not specified

10/07/2021: 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.

Wheelchair Seating

PA

Revision Effective Date: 10/01/2021
ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY:
Revised: ICD-10-CM code G71.20 description in Group 2 and Group 4 Codes, due to annual ICD-10-CM code updates
Added: ICD-10-CM code G04.82 to Group 2 and Group 4 Codes, due to annual ICD-10-CM code updates

10/07/2021: 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 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