LCD and Policy Article Revisions Summary for October 17, 2024 - JA DME
LCD and Policy Article Revisions Summary for October 17, 2024
Joint DME MAC Publication
Posted October 17, 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 External Infusion Pumps, Glucose Monitors, High Frequency Chest Wall Oscillation Devices, Knee Orthoses, Speech Generating Devices (SGD) and Wheelchair Seating. Please review the entire LCDs and related PAs for complete information.
External Infusion Pumps
LCD
Revision Effective Date: 10/01/2024
HCPCS CODES:
Removed: Code J1170 from Group 4 Codes
Added: Code J1171 to Group 4 Codes
10/17/2024: 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.
Glucose Monitors
LCD
Revision Effective Date: 10/01/2024
HCPCS CODES:
Revised: Long descriptor for HCPCS code A4271 in Group 2 Codes
10/17/2024: 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: 10/01/2024
CODING GUIDELINES:
Revised: Coding guideline information for HCPCS code A4271
10/17/2024: 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.
High Frequency Chest Wall Oscillation Devices
PA
Revision Effective Date: 10/17/2024
ICD-10-CM CODES THAT SUPORT MEDICAL NECESSITY:
Added: ICD-10-CM codes E74.02, E74.05, G72.49, and G72.9 to Group 1 Codes
10/17/2024: 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.
Knee Orthoses
LCD
Revision Effective Date: 10/01/2024
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Added: Code L1821 to prefabricated knee orthoses
Added: A row to the prefabricated knee orthoses table that contains base codes and addition codes that are not eligible for separate payment; this added row contains "L1821" as the Base Code and "None" in regard to Addition Codes – Eligible for Separate Payment
Added: A row to the prefabricated knee orthoses table that contains base codes and addition codes which can be physically incorporated into the base orthosis but that are not considered reasonable and necessary; this added row contains "L1821" as the Base Code and "L2397" as the Addition Codes – Not Reasonable and Necessary
HCPCS CODES:
Revised: Long descriptor for code L1820 in Group 1 Codes
Added: Code L1821 to Group 1 Codes
10/17/2024: 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: 10/01/2024
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: Code L1821 to the referenced prefabricated orthoses
CODING GUIDELINES:
Added: A row to the table that pertains to corresponding sets of HCPCS codes; the added row contains "L1820" in Column I and "L1821" in Column II
Revised: Long descriptor for HCPCS code L1820
Added: Coding guideline information for code L1821
Added: A row to the prefabricated knee orthoses table that contains base codes and addition codes that describe components or features that can be physically incorporated into the base orthosis but that are considered to be included in the allowance for the orthosis; the added row contains "L1821" as the Base Code and "L2390, L2750, L2780, L2810, L4002" as the Addition Codes – Not Separately Payable
Added: A row to the chart that reflects the reasonable useful lifetime of prefabricated knee orthoses; the row includes "L1821" as the Code and "1 Year" as the Reasonable Useful Lifetime
10/17/2024: 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.
Speech Generating Devices (SGD)
LCD
Revision Effective Date: 10/01/2024
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Added: "electromyographic sensor" to the accessories noted as covered when furnished to individuals with a demonstrated medical need for such accessories
HCPCS CODES:
Added: Code E2513 to Group 1 Codes
10/17/2024: 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: 10/01/2024
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: Code E2513 to billing information
Added: "Additionally, claims for HCPCS code E2599 must include the supplier price list (PL) amount." to billing information, as clarification
MODIFIERS:
Added: "E2513" to the HCPCS codes that require KX if all the coverage criteria are met
Added: "E2513" to the HCPCS codes for which claim lines billed without a KX, GA, or GZ modifier will be rejected as missing information
CODING GUIDELINES:
Revised: Information pertaining to methods of device access permitted by E2510, to include "electromyographic sensor" in the indirect selection techniques
Added: Coding guideline information for code E2513
10/17/2024: 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.
Wheelchair Seating
PA
Revision Effective Date: 10/17/2024
ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY:
Added: ICD-10-CM code G72.41 to Group 2 and Group 4 Codes
10/17/2024: 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.
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.
