Policy Article Revisions Summary for March 11, 2021

Outlined below are the principal changes to the DME MAC Policy Articles (PAs) that have been revised and posted. The policies included are Ankle-Foot/Knee-Ankle-Foot Orthoses, Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics), Orthopedic Footwear, Osteogenesis Stimulators, Speech Generating Devices (SGD), Spinal Orthoses: TLSO and LSO, Standard Documentation Requirements for All Claims Submitted to DME MACs and Vacuum Erection Devices (VED). Please review the entire LCDs and related PAs for complete information.

Ankle-Foot/Knee-Ankle-Foot Orthoses

PA

Revision Effective Date: 02/01/2021
CODING GUIDELINES:
Removed: Coding verification review information for HCPCS codes L1906 and L2006
CODING VERIFICATION REVIEW:
Added: Section header and PDAC coding verification review information
Added: Coding verification review information for HCPCS codes L1906 and L2006

03/11/2021: 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 Antiemetic Drugs (Replacement for Intravenous Antiemetics)

PA

Revision Effective Date: 01/01/2020
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Removed: HCPCS Codes Q0981 and Q9978 which are no longer valid for billing
CODING GUIDELINES:
Removed: HCPCS Codes Q9978 and Q9981 which are no longer valid for billing

03/11/2021: 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.

Orthopedic Footwear

PA

Revision Effective Date: 01/01/2020
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: HCPCS code L3000 to noncovered statement, previously omitted in error

03/11/2021: 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.

Osteogenesis Stimulators

PA

Revision Effective Date: 01/01/2020
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: Class III devices and KF modifier requirement for HCPCS codes E0747, E0748 and E0760
CODING GUIDELINES:
Removed: Class III devices and KF modifier requirements which were moved to the Policy Specific Documentation Requirements section

03/11/2021: 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.

Speech Generating Devices (SGD)

PA

Revision Effective Date: 01/01/2020
CODING GUIDELINES:
Added: "(PCL)" after reference to "Product Classification List"
Revised: Coding verification review information, to include incorrect coding denial language for products billed using HCPCS that require written coding verification review

03/11/2021: 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.

Spinal Orthoses: TLSO and LSO

PA

Revision Effective Date: 02/01/2021
CODING GUIDELINES:
Removed: Reference to L0640 from list of prefabricated orthoses
Removed: HCPCS codes L0622 and L0624 from list of custom fabricated orthoses for which all products must be listed on the PCL
Added: "(PCL)" after reference to "Product Classification List"
Revised: Coding verification review information, to include incorrect coding denial language for products billed using HCPCS that require written coding verification review

03/11/2021: 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.

Standard Documentation Requirements for All Claims Submitted to DME MACs

PA

STANDARD WRITTEN ORDER (SWO):
Revised: Reference to the Medicare Program Integrity Manual from 'Internet only manual' to 'CMS Pub.'
DOCUMENTATION REQUIREMENTS:
Revised: "DME MAC supplier" to "DMEPOS supplier" in second paragraph
CORRECT CODING:
Revised: Reference to the Medicare Program Integrity Manual from 'Internet only manual' to 'CMS Pub.'
Added: "45 CFR" in front of 162.1002 reference in first paragraph
Revised: 'Durable Medical Equipment Coding System' reference to 'DMECS' to match the PDAC website
REPAIRS/REPLACEMENT:
Revised: References to the Medicare Benefit Policy Manual from 'Internet only manual' to 'CMS Pub.'
SIGNATURE REQUIREMENTS:
Revised: Reference to the Medicare Program Integrity Manual from 'Internet only manual' to 'CMS Pub.'

03/11/2021: 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.

Vacuum Erection Devices (VED)

PA

Revision Effective Date: 01/01/2020
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: Social Security Act citation for non-coverage 1834(a)(1)(I)

03/11/2021: 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.

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

 

            Last Updated Thu, 29 Apr 2021 16:45:49 +0000