Medical Director Articles - 2017

Title Brief Description Last Updated
LCD and Policy Article Revisions Summary for December 21, 2017 The principal changes to the Lower Limb Prostheses, Wheelchair Options and Accessories, and Wheelchair Seating LCD and PA are outlined. The Standard Documentation Requirements for All Claims Submitted to the DME MACs PA is also updated. 12/21/17
LCD and Policy Article Revisions Summary for November 30, 2017 The principal changes to the External Infusion Pumps, High Frequency Chest Wall Oscillation Devices and Transcutaneous Electrical Nerve Stimulators (TENS) LCD and PA are outlined. 11/30/17
Correct Coding of CUVITRU - Revised The DME MACs have evaluated CUVITRU™ and determined that it is eligible for inclusion in the DME External Infusion Pump LCD. 11/30/17
RETIRED - Billing Instruction - Blinatumomab Blincyto - Revised Blinatumomab was approved for use by the Food and Drug Administration, and has been included in the DME MAC External Infusion Pumps LCD as a covered drug for the treatment of Philadelphia negative relapsed/refractory acute lymphoblastic leukemia. 11/22/17
Correct Coding - Urinary Drainage Tube Adapter A recent analysis of HCPCS code A4421 revealed that 69% of the claim lines submitted were incorrectly coded. Correct coding requires the use of a specific HCPCS code for Medicare billing when a specific code exists that appropriately describes the item provided.  11/22/17
Correct Coding - Hygienic Items, Wash Cloths, and Cleansing Wipes A recent analysis of HCPCS code A4649 revealed that 19% of the claim lines submitted were incorrectly coded. Correct coding requires the use of a specific HCPCS code for Medicare billing when a specific code exists that appropriately describes the item provided.  11/22/17
Correct Coding - Hygienic Cleansers, Diapers, and Underpads A recent analysis of HCPCS code A4335 revealed that 93% of the claim lines submitted were incorrectly coded. Correct coding requires the use of a specific HCPCS code for Medicare billing when a specific code exists that appropriately describes the item provided.  11/22/17
Correct Coding - Full Length Rocker Soles Added to Therapeutic Shoes A recent analysis of HCPCS code A5507 revealed that claim lines submitted were often incorrectly coded. Correct coding requires the use of a specific HCPCS code for Medicare billing when a specific code exists that appropriately describes the item provided.  11/22/17
Correct Coding - 2018 HCPCS Code Annual Update HCPCS Code changes for 2018. 11/22/17
Policy Article Revisions Summary for November 16, 2017 The principal changes to the DME MAC Standard Documentation Requirements for All Claims Submitted to the DME MACs Policy Article are outlined. 11/16/17
LCD and Policy Article Revisions Summary for October 26, 2017 The principal changes to the DME MAC Mechanical In-exsufflation Devices and Nebulizers LCD and Policy Article are outlined.   10/26/17
LCD Revision Summary for October 19, 2017 The principal changes to the DME MAC Wheelchair Seating LCD is outlined. 10/19/17
Correct Coding - Insulin Used with Continuous External Insulin Infusion Pumps The DME MACs have become aware of pharmacy billing to Medicare Part D for insulin used in a DME external insulin infusion pump. 10/19/17
Policy Article Revision Summary for October 12, 2017 The principal changes to the DME MAC Oral Anticancer Drugs Policy Article is outlined. 10/12/17
RETIRED - Correct Coding - PRO-FLEX® Prosthetic Foot (Össur) There have been recent inquiries to the DME MACs regarding the correct HCPCS coding to be used for Medicare billing of the Össur PRO-FLEX® prosthetic foot.  10/5/17
Correct Coding - Lithium Batteries - Revised Lithium ion batteries are commonly used in consumer electronic devices and are rechargeable.  Standard lithium batteries are disposable, non-rechargeable batteries.  Suppliers must take care to properly distinguish between lithium ion and lithium batteries when billing claims to Medicare. 9/21/17
Request for Information - Topical Oxygen Therapy Used for Wound Care The DME MACs announce the solicitation of scientific articles regarding the subject of topical oxygen therapy (TOT) used for wound care. 9/14/17
RETIRED - Surgical Dressings Comments and Response Summary - Revised In response to releasing the draft Surgical Dressing LCD and PA, the response to comments have also been released. 9/7/17
Correct Coding - HCPCS Coding of Surgical Dressing - Components to Report on the PDAC HCPCS Code Verification Application HCPCS coding of surgical dressing products requires reporting the amount (percent by weight) of each product's constituent components 9/7/17
LCD Revisions Summary for September 7, 2017 The principal changes to the DME MAC Knee Orthoses LCD is outlined. 9/7/17
LCD and Policy Article Revisions Summary for August 24, 2017 The principal changes to the DME MAC LCD and Policy Article for Wheelchair Seating is outlined. 8/24/17
Correct Coding - SpeediCath Felx Coude Catheter (Coloplast) Intermittent urinary catheters are eligible for Medicare payment when the requirements described in the Urological Supplies Local Coverage Determination (LCD L33803) and related Policy Article (A52521) are met. 8/24/17
Face-to-Face and Written Order Requirements for Certain Types of DME [PDF] 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. 8/17/17
RETIRED - Correct Coding - Submitting Diabetic Shoe Inserts for HCPCS Coding - PDACE Coding Application Instruction - Revised Inserts used with therapeutic shoes for persons with diabetes coded as A5512 and A5513 must meet certain specifications outlined in the Therapeutic Shoes for Persons with Diabetes LCD and related Policy Articles as well as the requirements for custom fabrication set out in the DMEPOS Quality Standards, Appendix C for A5513. 8/10/17
RETIRED - Correct Coding - A5513 Product Coding Redetermination Project Per the Coding Guidelines section of the Therapeutic Shoes for Persons with Diabetes LCD-Related Policy Article, manufacturers wishing to use A5513 for their product(s) are required to submit a coding verification application to the PDAC. 8/10/17
RETIRED - Correct Coding - Center Mount Elevating Leg Rest - Revised Recently it has come to the attention of the DME MACs that suppliers are billing separately for footplates or foot platforms used with a center mount elevating leg rest for power wheelchairs when the leg rest is initially billed to Medicare. 8/10/17
Correct Coding - Bariatric Pressure Reducing Support Surfaces The DME MAC Pressure Reducing Support Surfaces LCDs (PRSS Groups 1-3) and related Policy Articles include a variety of products including mattress pads/overlays, mattresses, and complete beds. 7/27/17
RETIRED - Correct Coding - A5513 Custom Molding Requirements Medicare provides coverage for therapeutic shoes and related inserts for beneficiaries with diabetes. 7/13/17
LCD and Policy Article Revisions Summary for June 29, 2017 The principal changes to the DME MAC LCD and Policy Article for External Infusion Pumps is outlined. 6/29/17
LCD and Policy Article Summary for June 8, 2017 - Drafts Released to Final The Surgical Dressings LCD and Policy Article have been finalized. 6/8/17
Policy Article Revisions Summary for June 8, 2017 The DME MAC Policy Article for Standard Documentation Requirements for All Claims Submitted to the DME MACs has been revised. 6/8/17
RETIRED - Surgical Dressings Comments and Response Summary In response to releasing the draft Surgical Dressing LCD and PA, the response to comments have also been released. These can be found attached to the LCD. 6/8/17
Policy Article Revisions Summary for June 1, 2017 The principal changes to the DME MAC Policy Article for Standard Documentation Requirements for All Claims Submitted to DME MACs has been revised. 6/1/17
LCD and Policy Article Revisions Summary for May 25, 2017 The principal changes to the policies for Negative Pressure Wound Therapy Pumps and Pressure Reducing Support Surfaces - Group 2 are outlined. The Standard Documentation Requirements for All Claims Submitted to the DME MACs Policy Article was also updated. 5/25/17
RETIRED - Glucose Monitors LCD and Related Policy Article - Revised The Glucose Monitors Local Coverage Determination (LCD) and Related Policy Article has been revised, effective for claims with dates of service on or after January 12, 2017, the date of CMS Ruling 1682R on continuous glucose monitors (CGM). 5/18/17
LCD and Policy Article Revisions Summary for May 18, 2017 The principal changes to the policies for Glucose Monitors, Suction Pumps and Transcutaneous Electrical Nerve Stimulators (TENS) are outlined. 5/18/17
LCD and Policy Article Revisions Summary for May 11, 2017 The principal changes to the policies for Eye Prosthesis, Facial Prostheses, Osteogenesis Stimulators, Patient Lifts, PAP Devices for Treatment of Obstructive Sleep Apnea, Pressure Reducing Support Surfaces - Group 1 and Group 3, Tracheostomy Care Supplies and Transcutaneous Electrical Joint Stimulation Devices are outlined. 5/11/17
E0118 - Crutch Substitute Section 1862 of the Social Security Act requires that an item or service must be "reasonable and necessary" before payment may be made. 5/4/17
LCD and Policy Article Revisions Summary for May 4, 2017 The principal changes to the policies for Automatic External Defibrillators, Intrapulmonary Percussive Ventilation System, Manual Wheelchair Bases, Oral Appliances for Obstructive Sleep Apnea, Ostomy Supplies, Pneumatic Compression Devices, Refractive Lenses, Speech Generating Devices, and Therapeutic Shoes for Persons with Diabetes are outlined. The Policy Article for Immunosuppressive Drugs was also updated. 5/4/17
RETIRED - Continuous Glucose Monitors - Frequently Asked Questions Frequently asked questions and answers about continuous glucose monitors. 5/4/17
LCD and Policy Article Revisions Summary for April 27, 2017 The principal changes to the policies for Heating Pads and Heat Lamps, Immunosuppressive Drugs, Infrared Heating Pad Systems, Mechanical Inexsufflation Devices, Orthopedic Footwear, Tumor Treatment Field Therapy, Vacuum Erection Devices and Walkers are outlined. 4/27/17
RETIRED - Billing Instructions - Continuous Glucose Monitors Questions have arisen about the proper billing of continuous glucose monitors (CGM) and the related supply allowance. 4/20/17
LCD and Policy Article Revisions Summary for April 20, 2017 The principal changes to the policies for Cold Therapy, Oxygen and Oxygen Equipment, Power Mobility Devices and Respiratory Assist Devices are outlined. The Standard Documentation Requirements for all claims submitted to the DME MAC Policy Article was also updated. 4/20/17
LCD and Policy Article Revisions Summary for April 6, 2017 The principal changes to the polices for Hospital Beds and Accessories, Lower Limb Prostheses, Nebulizers, Oral Anticancer Drugs and Parenteral Nutrition are outlined. 4/6/17
RETIRED - DIFs Usage for Enteral and Parenteral Nutrition and External Infusion Pumps - Revised The DME MACs use DME Information Forms (DIF) when processing claims to assure the most current information is on file and to allow the claims to pay correctly. 4/6/17
LCD and Policy Article Revisions Summary for March 30, 2017 The principal changes to the policies for Canes and Crutches, Cervical Traction Devices, External Breast Prostheses, High Frequency Chest Wall Oscillation Devices, Wheelchair Options/Accessories and Wheelchair Seating are outlined. 3/30/17
RETIRED - Coding and Coverage - Therapeutic Continuous Glucose Monitors (CGM) On December 20, 2016 the FDA granted premarket approval to Dexcom, Inc. for an expanded indication for their Dexcom G5® Mobile Continuous Glucose Monitoring (CGM) System. 3/23/17
LCD and Policy Article Revisions Summary for March 23, 2017 The principal changes to the policies for Commodes, Intravenous Immune Globulin, Negative Pressure Wound Therapy Pumps and Wheelchair Seating are outlined. 3/23/17
RETIRED - Standard Documentation Requirements for All Claims Submitted to DME MACs Many errors reported in Medicare audits are due to claims submitted with incomplete or missing requisite documentation. 3/16/17
Items Provided on a Recurring Basis and Request for Refill Requirements - Annual Reminder For all DMEPOS items and supplies provided on a recurring basis, billing must be based on prospective, not retrospective use. 3/16/17
Correct Coding and Coverage - Braces Constructed Primarily of Elastic or Other Fabric Materials - Revised For coverage under this benefit, the orthosis must be a rigid or semi-rigid device that is used for the purpose of supporting a weak or deformed body member or restricting or eliminating motion in a diseased or injured part of the body. 3/16/17
Correct Coding - Interferential Current Therapy Devices IFC Therapy is a form of electrotherapy in which two currents are applied and "crossed" resulting in a different frequency at the interference (crossing) point. 3/16/17
LCD and Policy Article Revisions Summary for March 16, 2017 The principal changes to the policies for AF/KAFO, Bowel Management Devices, Enteral Nutrition, External Infusion Pumps, Knee Orthoses, Oral Antiemetic Drugs, Seat Lift Mechanisms, Spinal Orthoses: TLSO and LSO, Urological Supplies and Wheelchair Options/Accessories are outlined. 3/16/17
Dear Clinician Letter - Completion of Certifications of Medical Necessity - Annual Reminder [PDF] Suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) are your partners in caring for your patient. They will not receive payment for their services until you return the completed, signed and dated CMN. 3/9/17
Reminder - Oxygen Qualification Tests and Documentation Suppliers are reminded that the CMS NCD for Home Oxygen Therapy and the DME MAC LCD and Policy Article both prohibit supplier involvement in the qualifying test process for home oxygen therapy. 3/9/17
RETIRED - DIFs Usage for Enteral and Parenteral Nutrition and External Infusion Pumps - Revised The DME MACs use DIFs when processing claims to assure the most current information is on file and to allow the claims to pay correctly. 1/20/17
Billing Instruction - Hospital Beds and Pressure Reducing Support Surfaces The DME MACs remind suppliers that billing a hospital bed with mattress in conjunction with a mattress-type support surface, not a support surface mattress overlay, is considered to be a claim for duplicate items. 1/5/17
DME MACs LCD Format Change The DME MACs will be revising the documentation requirements section of all LCDs during our CMS-required annual LCD review. 1/5/17

 

Last Updated Dec 20, 2018