Policy Article Revisions Summary for March 14, 2024 - JA DME

Joint DME MAC Publication
Posted March 14, 2024

Outlined below are the principal changes to the DME MAC Policy Articles (PAs) that have been revised and posted. The policies included are External Infusion Pumps, Intravenous Immune Globulin and Nebulizers. Please review the entire Local Coverage Determinations (LCDs) and related PAs for complete information.

External Infusion Pumps

PA

Revision Effective Date: 01/12/2024
MODIFIERS:
Added: "Effective January 1, 2024, the JZ modifier is also required when billing for drugs and biologicals from single-dose containers that are dispensed by the supplier but self-administered by the beneficiary or the beneficiary’s caregiver."
Revised: "The JW and JZ modifiers are not required for drugs dispensed by the supplier and self-administered by the patient or caregiver in the patient’s home." to "The JW modifier is not required for drugs dispensed by the supplier and self-administered by the beneficiary or caregiver in the beneficiary’s home, as it is not expected that the beneficiary or their caregiver provide discarded drug information to the supplier. The JZ modifier is required in this scenario (effective for claims with dates of service on or after January 1, 2024)."
Removed: The JZ modifier from the statement regarding expected rare use
Added: "As of July 1, 2023, the JZ modifier is required in this situation." to Scenario 2
Added: Information to include the JZ modifier in the billing instructions for the 70 mg dose in Scenario 2

03/14/2024: 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.

Intravenous Immune Globulin

PA

Revision Effective Date: 01/01/2024
MODIFIERS:
Added: "Effective January 1, 2024, the JZ modifier is also required when billing for drugs and biologicals from single-dose containers that are dispensed by the supplier but self-administered by the beneficiary or the beneficiary’s caregiver."
Revised: "The JW and JZ modifiers are not required for drugs dispensed by the supplier and self-administered by the patient or caregiver in the patient’s home." to "The JW modifier is not required for drugs dispensed by the supplier and self-administered by the beneficiary or caregiver in the beneficiary’s home, as it is not expected that the beneficiary or their caregiver provide discarded drug information to the supplier. The JZ modifier is required in this scenario (effective for claims with dates of service on or after January 1, 2024)."
Removed: The JZ modifier from the statement regarding expected rare use
Added: "As of July 1, 2023, the JZ modifier is required in this situation." to Scenario 2
Added: Information to include the JZ modifier in the billing instructions for the 70 mg dose in Scenario 2

03/14/2024: 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.

Nebulizers

PA

Revision Effective Date: 01/01/2024
MODIFIERS:
Added: "Effective January 1, 2024, the JZ modifier is also required when billing for drugs and biologicals from single-dose containers that are dispensed by the supplier but self-administered by the beneficiary or the beneficiary’s caregiver."
Revised: "The JW and JZ modifiers are not required for drugs dispensed by the supplier and self-administered by the patient or caregiver in the patient’s home." to "The JW modifier is not required for drugs dispensed by the supplier and self-administered by the beneficiary or caregiver in the beneficiary’s home, as it is not expected that the beneficiary or their caregiver provide discarded drug information to the supplier. The JZ modifier is required in this scenario (effective for claims with dates of service on or after January 1, 2024)."
Removed: The JZ modifier from the statement regarding expected rare use.
Added: "As of July 1, 2023, the JZ modifier is required in this situation." to Scenario 2
Added: Information to include the JZ modifier in the billing instructions for the 70 mg dose in Scenario 2

03/14/2024: 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:

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.