Medical Director Articles - 2016

Title Brief Description Last Updated
LCD and Policy Article Revisions Summary for December 29, 2016

The principal changes to the policies for External Infusion Pumps and Intravenous Immune Globulin are outlined.

12/29/16
Correct Coding - WHILL Powered Personal Mobility Devices - Revised WHILL, Inc.,  is the manufacturer of WHILL powered personal mobility devices.  12/15/16
RETIRED - Correct Coding - Negative Pressure Wound Therapy (NPWT) As noted in the Negative Pressure Wound Therapy LCD and related Policy Article the allowance for wound dressings HCPCS code A6550 includes all items necessary for the effective utilization of the wound pump.  12/15/16
RETIRED - Correct Coding - Manual Wheelchairs Constructed of Titanium A recent review of K0108, identified increased billing for items that are characterized by titanium construction or heavy-duty packages constructed with titanium.  12/15/16
Correct Coding - Oral Appliances Not Used For the Treatment of Obstructive Sleep Apnea Oral appliances are used for the treatment of many conditions related to the mouth, teeth and jaw. 12/08/16
Correct Coding - LIM Innovation Below Knee Socket - Revised Infinite Socket™ (LIM innovations) is an open-frame below-knee socket design that has recently become available. This product uses struts that extend from a base to an adjustable brim enclosing an inner shell to form the structure of the socket.  12/08/16

Correct Coding - Diapers and Underpads

Recent reports have identified that suppliers are billing HCPCS code A9999 for diapers and underpads. These miscellaneous codes are not the correct codes to use for billing these items.  12/08/16
RETIRED - Correct Coding - NOC HCPCS Codes Used for Drugs Correct coding requires an item be coded with the most specific code available that appropriately describes the item.  12/01/16
Correct Coding - 2017 HCPCS Code Annual Update The following tables identify changes to Level II Healthcare Common Procedure Coding System (HCPCS) codes for 2017.  12/01/16
RETIRED - Correct Coding - Eclipse Vaginal Insert System - Revised This article is revised to retract the coding guidance issued by the DME MACs in August 2016 for the Eclipse™ Vaginal Insert system. 11/10/16
RETIRED - Correct Coding of Cuvitru On September 13, 2016, Cuvitru (Shire) was approved by the FDA. Cuvitru is a 20% solution of human immune globulin, which is administered subcutaneously, and is indicated as replacement therapy for primary humoral immunodeficiency (PI) in adults. 11/10/16
LCD and Policy Article Revisions Summary for November 10, 2016 The principal changes to the polices for Bowel Management Devices, Commodes, Eye Prostheses, Facial Prostheses and PAP Devices for the treatment of Obstructive Sleep Apnea are outlined. 11/10/16
LCDs and Policy Articles Updated with 2017 ICD-10 Annual Updates - Effective October 1, 2016 The following list identifies the Local Coverage Determination (LCD) or Policy Article (PA) and the ICD-10 codes that were added, deleted and revised. 10/20/16

LCD and Policy Article Revisions Summary for October 6, 2016

The principal changes to the policies for External Infusion Pumps, Glucose Monitors, Knee Orthoses, Oral Antiemetic Drugs, Therapeutic Shoes for Persons with Diabetes are outlined.

10/6/16
RETIRED - Correct Coding- Otto Bock C-Leg Coding - Revised The Otto Bock C-Leg is a microprocessor controlled prosthetic knee. The product is covered by Medicare for beneficiaries classified as K-level 3 or 4. 10/6/16
Correct Coding - Argus® II Retinal Prosthesis System The Argus® II Retinal Prosthesis System (Second Sight Medical Products, Inc.) is an implanted retinal prosthesis. 9/22/16
RETIRED - Correct Coding - Pneumatic Compression Devices and Related Appliances - Revised Pneumatic compression devices (PCD) consist of an electrical pneumatic pump and an inflatable appliance that encloses the applicable body part. 9/22/16
LCD and Policy Article Revisions Summary for September 1, 2016 The principal changes to the policies for Canes and Crutches, Cervical Traction Devices, External Breast Prostheses and Power Mobility Devices are outlined. 9/1/16
LCD and Policy Article Revisions Summary for August 25, 2016 The principal changes to the policies for Pressure Reducing Support Services - Groups 1, 2 and 3 are outlined. 8/25/16
LCD and Policy Article Revisions Summary for August 18, 2015 The principal changes to the policies for Automatic External Defibrillators, Heating Pads and Heat Lamps and High Frequency Chest Wall Oscillations Devices are outlined. 8/18/16
LCD and Policy Article Revisions Summary for August 11, 2016 The principal changes to the policies for  Bowel Management Devices, Nebulizers and Oral Anti-Cancer Drugs are outlined. 8/11/16
LCD Revisions Summary for August 4, 2016 The principal changes to the policy for Knee Orthoses is outlined. 8/04/16
Correct Coding - Cantilever Type Armrest A cantilever or flip up armrest is a non-detachable armrest that pivots to move the armrest away from the patient in a fashion analogous to a swing-away armrest. 7/28/16
Correct Coding and Coverage - Braces Constructed Primarily of Elastic or Other Fabric Materials Comprehensive discussion of statutory benefit category requirements and HCPCS coding guidelines applicable to braces constructed primarily of elastic or other fabric materials. 7/28/16
Certificates of Medical Necessity and DME Information Forms The Final Notice extending the use of all CMNs and DIFs was published in the Federal Register on May 11, 2016, and all forms have been extended through 2019. 7/21/16
Correct Coding - WHILL Powered Personal Mobility Devices WHILL, Inc., (San Carlos, CA), is the manufacturer of WHILL powered personal mobility devices. They currently have two products, Model A and Model M. 7/21/16
Correct Coding and Coverage of Oral Suspensions used in the Treatment of Oral Mucosal Injures Claim submission instructions for products used by beneficiaries for oral mucosal injuries are provided. 7/21/16
Correct Coding - HCPCS Coding Recommendations from Non-Medicare Sources Use of the appropriate HCPCS code assures that accurate processing can be accomplished resulting in a proper claim determination and reimbursement. 7/21/16
LCD and Policy Article Revisions Summary for July 7, 2016 The principal changes to the policy for Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) is outlined. 7/7/16
Correct Coding - JW Modifier Use - Revised - Effective for Claims with Dates of Service On or After January 1, 2017 CMS recently issued updated guidance on the billing of drug wastage to require use of the JW modifier. 6/16/16
RETIRED - Correct Coding - Martin Bionics Socket-less Socket - Revised HCPCS code L5999 which is currently used for billing purposes, is being replaced with specific L-codes effective for dates of service on or after June 1, 2016. 6/9/16
Retired - Coverage and Coding - New Oral Antiemetic Drug Varubi - Effective Date July 1, 2016 The U.S. Food and Drug Administration approved Varubi (rolapitant) on September 2, 2015. 5/26/16
Correct Coding - Powered Exoskeleton Products Items described as powered exoskeletons have been developed to support mobility for beneficiaries with spinal cord injuries who are unable to ambulate. 5/19/16
LCD and Policy Article Revisions Summary for May 19, 2016 The principal changes to the Knee Orthoses policy are outlined. 5/19/16
Billing for External Infusion Pumps and Drugs When Treatment Was Initiated Somewhere Other Than the Beneficiary's Home The DME MACs have identified situations where drug infusions initiated in settings other than the beneficiary's home have resulted in infusion pump, related infusion supplies, and/or infused drug being billed erroneously. 5/5/16
RETIRED - Correct Coding and Coverage of Ventilators - May 2016 This article has been revised to reflect clarifications on coding and coverage requirements for ventilators in the Frequent and Substantial Servicing (FSS) payment category and to remove ventilator codes that were retired effective January 1, 2016. 5/5/16
RETIRED - Affordable Care Act 6407 - Supplier Frequently Asked Questions - Revised This FAQ is revised to update the criteria associated with the written order prior to delivery and face-to-face examination. 4/28/16
RETIRED - Correct Coding Reminder - Duopa (AbbVie) For dates of service on or after January 9, 2015, through December 31, 2015, claims for Duopa must be submitted using the DME miscellaneous code J7799. 4/28/16
Face-to-Face and Written Order Requirements for Certain Types of DME The CMS regulation contains the detail for the face-to-face examination, written order prior to delivery and the list of items subject to these requirements. 4/28/16
RETIRED - Face-to-Face Examination and Prescription Requirements Prior to the Delivery of Certain DME Items Specified in the Affordable Care Act - Revised This FAQ is revised to update the criteria associated with the five-element written order prior to delivery (5EO) and face-to-face examination. 4/28/16
Standard Documentation Language for Local Coverage Determinations and Related Policy Articles - Revised This revision updates the requirements for orders and face-to-face examinations, in compliance with the Affordable Care Act (ACA) Section 6407. 4/28/16
Correct Coding - Manual Wheelchair Bases - Revised For Medicare coding purposes, all manual wheelchair base codes describe a complete product. Coding applications describing products that are not complete have been received by the Pricing, Data Analysis and Coding (PDAC) contractor. 4/14/16
LCD and Policy Article Summary Revisions - March 17, 2016 The principal changes to the Urological Supplies policy are outlined. 3/17/16
Correct Coding - LIM innovations Infinite Socket Infinite Socket (LIM innovations) is an open-frame above-knee socket design that has recently became available. 3/10/16
Hand-Finger Orthoses - Use of CG Modifier If a garment made with elastic material has a rigid plastic or metal component, it is considered a non-elastic orthosis for purpose of coverage and coding. 3/10/16
LCD and Policy Article Summary Revisions - March 3, 2016 The principal changes to the policies for Ankle-Foot/Knee-Ankle-Foot Orthosis, Bowel Management Devices, External Infusion Pumps, Immunosuppressive Drugs, Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics), Parenteral Nutrition, Respiratory Assist Devices, and Wheelchair Options/Accessories are outlined. 3/3/16
RETIRED - Correct Coding - inFlow™ Intraurethral Valve-Pump (Vesiflo, Inc.) The inflow Intraurethral Valve-Pump is a urinary device for women with incomplete bladder emptying due to impaired detrusor contractility (IDC). 2/18/16
RETIRED - Correct Coding - NOC Codes for Enteral (B9998) and Parenteral (B9999) Nutrition Recent claims analysis of the "Not Otherwise Classified" (NOC) codes used with enteral and parenteral nutrition claims identified errors in the use of these codes. 2/12/16
Completion of Certifications of Medical Necessity - Annual Reminder This letter reminds physicians that If they have ordered equipment or supplies as part of the patient's treatment plan, completing the CMN accurately and in a timely manner helps insure that the treatment plan will be carried out. 1/28/16
Items Provided on a Recurring Basis and Request for Refill Requirements For all DMEPOS items provided on a recurring basis, billing must be based on prospective, not retrospective, use. 1/28/16
Correct Coding - IDEO and ExoSym Energy Storing AFO Recent claim experience for the IDEO™ and ExoSym™ has demonstrated that HCPCS coding guidance for Medicare billing is necessary to prevent errors. 1/28/16
Reminder - Ordering Physician and CMS-1500 Claim Form Suppliers are strongly encouraged to check their documentation from referring physicians or other healthcare practitioners and ensure that the information listed in Item 17 and Item17b on the CMS-1500 form for the referring provider matches the information on the order for any item of DMEPOS. 1/14/16
Coverage and Correct Coding - Yondelis On October 23, 2015, FDA gave accelerated approval to YONDELIS (trabectedin), a chemotherapy treatment for specific soft tissue sarcomas that cannot be removed by surgery (unresectable) or is advanced (metastatic). 1/7/16
RETIRED - Coverage and Correct Coding - Blincyto This is a revision to a previous version published February 20, 2015, and adds the new HCPCS code for blinatumomab. 1/7/16
Coverage and Correct Coding - Duopa This is a revision to a previous version published February 20, 2015, and adds the new HCPCS code for Duopa. 1/7/16
Coverage and Correct Coding - HyQvia This is a revision to a previous version published July 30, 2015 and adds the new HCPCS code for HYQVIA. 1/7/16

 

Last Updated Jun 07, 2019