LCD and Policy Article Revisions Summary for May 2, 2024 - JA DME
LCD and Policy Article Revisions Summary for May 2, 2024
Joint DME MAC Publication
Posted May 2, 2024
Outlined below are the principal changes to the DME MAC Local Coverage Determinations (LCDs) and Policy Articles (PAs) that have been revised and posted. The policies included are Glucose Monitors, Immunosuppressive Drugs, Lower Limb Prostheses, Walkers and Wheelchair Options/Accessories. Please review the entire LCDs and related PAs for complete information.
Glucose Monitors
LCD
Revision Effective Date: 04/01/2024
HCPCS CODES:
Added: Codes E2104 to Group 1 Codes and A4271 to Group 2 Codes
05/02/2024: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates per CMS HCPCS coding determinations.
PA
Revision Effective Date: 04/01/2024
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: Codes E2104 and A4271 to "Code A4238 does not include a home BGM (HCPCS codes E0607, E2100, E2101, E2104) and related BGM testing supplies (HCPCS codes A4233, A4234, A4235, A4236, A4244, A4245, A4246, A4247, A4250, A4253, A4255, A4256, A4257, A4258, A4259, A4271)."
MODIFIERS:
Added: Codes E2104 and A4271
CODING GUIDELINES:
Added: Codes E2100, E2101 and E2104 to home BGMs
Revised: "The test strips may be separate items that are inserted into the monitor or self-contained in a cylinder or disk-type mechanism." to "The test strips/test reagents may be separate items that are inserted into the monitor or self-contained in a cartridge or disk-type mechanism."
Added: "In addition, the lancing device and lancets may be separate items or integrated into a cartridge or other similar integrated mechanism."
Revised: "BGMs with integrated voice synthesizers (code E2100) are devices that measure capillary whole blood for determination of blood glucose levels. Results are displayed on a screen but are also digitalized and converted to sound output." to "Code E2100 describes a blood glucose monitor with an integrated voice synthesizer. Results are displayed on a screen and are digitized and converted to sound output."
Revised: "BGMs with integrated lancing and/or blood sampling (code E2101) are devices that measure capillary whole blood for determination of blood glucose levels." to "Codes E2101 and E2104 describe blood glucose monitors with an integrated lancing and/or blood sampling mechanism."
Added: "Code A4271 describes a cartridge with integrated lancing and blood sample testing sufficient to perform ten (10) blood glucose tests. The "per month" HCPCS descriptor represents one (1) unit of service (UOS) of code A4271 and is equivalent to 100 test strips and 100 lancets."
Added: Code E2104 to Column I and A4233, A4234, A4235, A4236 to corresponding Column II
ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY:
Added: ICD-10-CM codes E11.10 and E11.11 to Group 1 Codes (Effective for claims with dates of service on or after October 1, 2017)
05/02/2024: 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.
Immunosuppressive Drugs
LCD
Revision Effective Date: 04/01/2024
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Added: J2919 as methylprednisolone HCPCS code
Removed: J2920 and J2930 as methylprednisolone HCPCS codes
HCPCS CODES:
Added: HCPCS code J2919
Removed: HCPCS codes J2920 and J2930
Revised: HCPCS J7516 narrative from "CYCLOSPORIN, PARENTERAL, 250 MG" to "INJECTION, CYCLOSPORINE, 250 MG"
05/02/2024: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates per CMS HCPCS coding determinations.
Lower Limb Prostheses
LCD
Revision Effective Date: 04/01/2024
HCPCS CODES:
Added: HCPCS codes L5841 and L5783
05/02/2024: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates per CMS HCPCS coding determinations.
PA
Revision Effective Date: 04/01/2024
CODING GUIDELINES:
Added: HCPCS code L5783 coding guideline information
05/02/2024: 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.
Walkers
PA
Revision Effective Date: 04/01/2024
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: "A powered walker (E0152) is noncovered as it does not meet the definition of DME."
05/02/2024: 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.
Wheelchair Options/Accessories
LCD
Revision Effective Date: 04/01/2024
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Removed: "(E2300)" from language pertaining to power seat elevation systems
Added: "(E2298)" to language pertaining to power seat elevation systems
HCPCS CODES:
Removed: E2300 from Group 6 Codes
Added: E2298 to Group 6 Codes
05/02/2024: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates per CMS HCPCS coding determinations.
PA
Revision Effective Date: 04/01/2024
CODING GUIDELINES:
Revised: "(E2300)" to "(E2300 or E2298 depending on DOS - See below)"
Added: Information pertaining to coding of seat elevation systems on claims for DOS on or before March 31, 2024 and on or after April 1, 2024
05/02/2024: 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:
- Open the currently effective policy on the Medical Coverage Database (MCD)
- Links to the MCD can be found on the Active LCDs page on the Noridian website
- 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
- There are direct links to all LCDs under the ‘LCD ID number and Effective Date’ column
- Links to the MCD can be found on the Active LCDs page on the Noridian website
- Scroll down to the bottom of the policy
- Find the section labeled Public Version(s)
- Look for the link to the policy that was effective on the dates of service in question.
- Click on hyperlink to go to the policy.
