Article Detail - JA DME

Outlined below are the principal changes to the DME MAC Policy Article (PA) that has been revised and posted. The policy included is Lower Limb Prostheses. Please review the entire Local Coverage Determination (LCD) and related PA for complete information.

Lower Limb Prostheses

PA

Revision Effective Date: 03/21/2023
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Revised: Language pertaining to payment of a prosthesis when provided in a Part A covered hospital stay and Part A covered skilled nursing facility (SNF) stay
Added: “The prosthesis is reasonable and necessary for a beneficiary’s use during the Medicare Part A covered SNF stay” as a criterion for payment of a prosthesis delivered to a beneficiary during a Part A covered SNF stay when eligible for DME MAC coverage and payment
Added: “The prosthetic components are classified as major category III codes under the SNFs consolidated billing” as a criterion for payment of a prosthesis delivered to a beneficiary during a Part A covered SNF stay when eligible for DME MAC coverage and payment

01/26/2023: 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.

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.

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