Policy Article Revisions Summary for November 19, 2020

Posted November 19, 2020

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, Knee Orthoses, Spinal Orthoses: TLSO and LSO and Therapeutic Shoes for Persons with Diabetes. Please review the entire LCDs and related PAs for complete information.

Ankle-Foot/Knee-Ankle-Foot Orthoses

PA

Revision Effective Date: 02/01/2021

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Revised: Prefabricated orthoses (OTS or custom-fit) incorrect coding denial language, by removing “with a statutory denial”
Added: Definitions of prefabricated and custom fabricated orthoses
Clarified: Billing of custom fabricated additions

CODING GUIDELINES:
Added: Coding guideline information for HCPCS code L2005

11/19/2020: 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.

Knee Orthoses

PA

Revision Effective Date: 02/01/2021

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Revised: Denial language for custom fitted orthoses to remove “with a statutory denial”

11/19/2020: 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.

Spinal Orthoses: TLSO and LSO

PA

Revision Effective Date: 02/01/2021

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Revised: Prefabricated orthoses (OTS or custom-fit) incorrect coding denial language, by removing “with a statutory denial”
Added: Definitions of prefabricated and custom fabricated orthoses
Clarified: Billing of custom fabricated additions

11/19/2020: 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.

Therapeutic Shoes for Persons with Diabetes

PA

Revision Effective Date: 11/05/2020

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Revised: Certifying physician information, to clarify NPs or PAs practicing ‘incident to’ supervising physician

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Revised: “detailed written order” to “SWO”
Revised: Certifying physician information, to clarify NPs or PAs practicing ‘incident to’ supervising physician

11/19/2020: 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, 19 Nov 2020 14:03:32 +0000