LCD and Policy Article Revisions Summary for September 17, 2020

Posted September 17, 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 External Infusion Pumps. Please review the entire LCD and related PA for complete information.

External Infusion Pumps

LCD

Revision Effective Date: 09/15/2020
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Removed: Information related to HCPCS code E0787, which is invalid for Medicare submission for DOS on or after 9/15/2020
Added: Information regarding external ambulatory insulin infusion pumps that incorporate dose rate adjustment using therapeutic continuous glucose sensing

CODING INFORMATION:
Removed: HCPCS code E0787 from Group 1 HCPCS Codes
Removed: HCPCS code A4226 from Group 2 HCPCS Codes

09/17/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are due to Non-Discretionary HCPCS code changes rendering them invalid for submission to Medicare.

PA

Revision Effective Date: 09/15/2020
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Removed: Information related to HCPCS code E0787, which is invalid for Medicare submission for DOS on or after 09/15/2020

MODIFIERS:
Removed: HCPCS code E0787

CODING GUIDELINES:
Removed: Guidelines for HCPCS codes E0787 and A4226
Added: Coding guidelines for insulin infusion pumps with integrated continuous glucose sensing
capabilities

ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:
Removed: HCPCS code E0787 from Group 1 Paragraph

09/17/2020: 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, 17 Sep 2020 14:32:53 +0000