Policy Article Revision Summary for December 5, 2024 - JA DME

Joint DME MAC Publication
Posted on December 5, 2024

Outlined below are the principal changes to the DME MAC Policy Articles (PAs) that have been revised and posted. The policies included are Nebulizers, Surgical Dressings, and Therapeutic Shoes for Persons with Diabetes. Please review the entire Local Coverage Determinations (LCDs) and related PAs for complete information.

Nebulizers

PA

Revision Effective Date: 01/01/2024
CODING GUIDELINES:
Revised: "0.83%" to "0.083%" in the example regarding the provision of albuterol solution and billed units of service for HCPCS code J7613

12/05/2024: At this time the 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.

Surgical Dressings

PA

Revision Effective Date: 12/05/2024
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS
Removed: "The size of the dressing (if applicable); and," from the documentation list the treating practitioner's medical record, nursing home, or home care nursing records must specify for initial wound evaluations
Added: "Claim lines for A6501, A6502, A6503, A6504, A6505, A6506, A6507, A6508, A6509, A6510, A6511, A6512, and A6513 do not require the A1-A9 modifier or the AW modifier."

12/05/2024: At this time the 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: 12/05/2024
CODING GUIDELINES:
Revised: "If an insert is not included in one of these categories of items (A5512, A5513, A5514), it must be billed with code A5510 or A9270 (noncovered item)." to "If an insert for a diabetic shoe does not meet the coding guidelines of A5512, A5513, or A5514, then the insert must be billed using either HCPCS code A5510 or A9270 (noncovered item)." as clarification
Removed: Coding verification review information for HCPCS codes A5512, A5513, and A5514
CODING VERIFICATION REVIEW:
Added: Section header and PDAC coding verification review information
Added: Coding verification review information for HCPCS codes A5512 and A5513
Added: Coding verification review information for HCPCS code A5514, for claims with dates of service on or after January 1, 2019 through December 4, 2024
Added: Coding verification review information for HCPCS code A5514, for claims with dates of service on or after December 5, 2024

12/05/2024: 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/or PAs. For complete information on any topic, you must review the LCDs and/or PAs.

With the update(s) 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.