LCD and Policy Article Revisions Summary for February 14, 2019 - JA DME
LCD and Policy Article Revisions Summary for February 14, 2019
Outlined below are the principal changes to the DME MAC Local Coverage Determinations (LCDs) and Policy Articles that have been revised and posted. The policies included are: Cold Therapy, Enteral Nutrition, External Breast Prostheses, External Infusion Pumps, High Frequency Chest Wall Oscillation Devices, Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics), Oxygen and Oxygen Equipment, Spinal Orthoses: TLSO and LSO, and Wheelchair Options and Accessories. Please review the entire LCDs and related PAs for complete information.
Cold Therapy
LCD
Revision Effective Date: 01/01/2019
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Revised: Code descriptor for E0218 from water to fluid
HCPCS CODES:
Revised: Code descriptor for A9273 from water to fluid and expanded to include cold or hot fluid
Revised: Code descriptor for E0218 from water to fluid
PA
Revision Effective Date: 01/01/2019
CODING GUIDELINES:
Revised: Coding guidelines for A9270
Added: Coding guideline for A9273
Revised: Code descriptor for E0218 from water to fluid per annual HCPCS code update
02/14/2019: 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.
Enteral Nutrition
LCD
Revision Effective Date: 01/01/2019
HCPCS CODES:
Added: HCPCS B4105
PA
Revision Effective Date: 01/01/2019
CODING GUIDELINES:
Revised: 'these supplies' to 'these supply allowances' for enteral feeding supplies
Added: In-Line Cartridge Coding Guidelines and billing instructions for Q9994 and B4105
02/14/2019: 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.
External Breast Prostheses
LCD
Revision Effective Date: 01/01/2019
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Removed: Statement to refer to diagnosis code section below
Added: Refer to Covered ICD-10 Codes in the LCD-related Policy Article
ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:
Moved: All diagnosis codes to the LCD-related Policy Article diagnosis code section per CMS instruction
ICD-10 CODES THAT DO NOT SUPPORT MEDICAL NECESSITY:
Moved: Statement about noncovered diagnosis code moved to LCD-related Policy Article noncovered diagnosis section per CMS instruction.
PA
Revision Effective Date: 01/01/2019
CODING GUIDELINES:
Added: Lycra to L8000 code description
Revised: RT and/or LT modifier instructions
ICD-10 CODES THAT ARE COVERED:
Added: All diagnosis codes formerly listed in the LCD
ICD-10 CODES THAT ARE NOT COVERED:
Added: Notation excluding all unlisted diagnosis codes from coverage
02/14/2019: 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.
External Infusion Pumps
LCD
Revision Effective Date: 01/01/2019
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Removed: Statement to refer to diagnosis code section below
Added: Refer to Covered ICD-10 Codes in the LCD-related Policy Article
Revised: Effective for claims with dates of service on or after 03/29/2018 allow additional cycles of Blinatumomab (J9039)
HCPCS CODES:
Added: HCPCS codes G0068, G0069, and G0070 to Group 3 codes
ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:
Moved: All diagnosis codes to the LCD-related Policy Article diagnosis code section per CMS instruction
ICD-10 CODES THAT DO NOT SUPPORT MEDICAL NECESSITY:
Moved: Statement about noncovered diagnosis code moved to LCD-related Policy Article noncovered diagnosis section per CMS instruction
PA
Revision Effective Date: 01/01/2019
CODING GUIDELINES:
Added: Professional services description
ICD-10 CODES THAT ARE COVERED:
Added: All diagnosis codes formerly listed in the LCD
ICD-10 CODES THAT ARE NOT COVERED:
Added: Notation excluding all unlisted diagnosis codes from coverage
02/14/2019: 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.
High Frequency Chest Wall Oscillation Devices
LCD
Revision Effective Date: 01/01/2019
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Removed: Statement to refer to diagnosis code section below
Added: Refer to Covered ICD-10 Codes in the LCD-related Policy Article
HCPCS CODES:
Revised: Code descriptor for E0483
ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:
Moved: All diagnosis codes to the LCD-related Policy Article diagnosis code section per CMS instruction
ICD-10 CODES THAT DO NOT SUPPORT MEDICAL NECESSITY:
Moved: Statement about noncovered diagnosis codes moved to LCD-related Policy Article noncovered diagnosis code section per CMS instruction
PA
Revision Effective Date: 01/01/2019
CODING GUIDELINES:
Revised: Code descriptor for E0483
ICD-10 CODES THAT ARE COVERED:
Added: All diagnosis codes formerly listed in the LCD
ICD-10 CODES THAT ARE COVERED:
Added: Notation excluding all unlisted diagnosis codes from coverage
02/14/2019: 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)
LCD
Revision Effective Date: 01/01/2019
HCPCS CODES:
Added: "ORAL" to HCPCS code J8655
PA
Revision Effective Date: 01/01/2019
CODING GUIDELINES:
Added: "ORAL" to HCPCS code J8655 code description
02/14/2019: 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.
Oxygen and Oxygen Equipment
LCD
Revision Effective Date: 01/01/2019
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Removed: NCD language
Removed: Statement to refer to diagnosis code section below
Added: Refer to Covered ICD-10 Codes in the LCD-related Policy Article
HCPCS CODES:
Added: HCPCS E0447
ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:
Moved: All diagnosis codes to the LCD-related Policy Article diagnosis code section per CMS instruction
ICD-10 CODES THAT DO NOT SUPPORT MEDICAL NECESSITY:
Moved: Statement about noncovered diagnosis code moved to LCD-related Policy Article noncovered diagnosis code section per CMS instruction
PA
Revision Effective Date: 01/01/2019
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: E0447 to Oxygen Content guidelines
CODING GUIDELINES:
Added: E0467 Coding Guidelines
Revised: E1405 and E1406 Coding Guidelines
ICD-10 CODES THAT ARE COVERED:
Added: All diagnosis codes formerly listed in the LCD
ICD-10 CODES THAT ARE NOT COVERED:
Added: Notation excluding all unlisted diagnosis codes from coverage
02/14/2019: 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: 01/01/2019
CODING GUIDELINES:
Revised: Coding instructions for prefabricated orthoses without distinction of OTS or custom-fit.
02/14/2019: 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.
Wheelchair Options and Accessories
LCD
Revision Effective Date: 01/01/2019
HCPCS CODES:
Revised: K0037 narrative to remove "replacement only"
PA
Revision Effective Date: 01/01/2019
CODING GUIDELINES:
Removed: K0037 from "replacement only" items
Revised: RT and LT modifier billing instructions (Effective 03/01/2019)
02/14/2019: 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.
