The Power of the Policy Article

While local coverage determinations (LCDs) provide policy coverage criteria, policy articles provide much more specific guidelines for the successful provision and billing of DME items and services. Take a look at some of the topics that are found in the policy articles.

  • Non-medical necessity
  • Payment rules
  • Final Rule 1713 (face-to-face, written order prior to delivery (WOPD) requirements)
  • Policy specific documentation requirements
  • General requirements (specific to the policy)
    • Correct billing instructions
  • Modifiers (general and policy specific)
  • Miscellaneous information
  • Coding guidelines and instructions
    • Diagnosis codes
    • HCPCS codes
    • Group codes
    • Codes that include multiple products
  • Revision history information (check changes to the policy)
  • Medical need

At the bottom of the policy article, is an Associated Documents section. Here you will find links to items including necessary attachments like certification documents, Certificate of Medical Necessity (CMN), the LCD, Standard Documentation Requirements article (A55426), and the National Coverage Determination (NCD).

            Last Updated Fri, 19 Nov 2021 17:53:46 +0000