Policy Article Revisions Summary for March 21, 2024 - JA DME

Joint DME MAC Publication
Posted March 21, 2024

Outlined below are the principal changes to the DME MAC Policy Articles (PAs) that have been revised and posted. The policies included are Eye Prostheses, Facial Prostheses and Oxygen and Oxygen Equipment. Please review the entire Local Coverage Determinations (LCDs) and related PAs for complete information.

Eye Prostheses

PA

Revision Effective Date: 01/01/2020
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES
Removed: "Claims for eye prostheses from nonphysicians provided in an office or nursing home setting are submitted to the DME MAC. Claims for eye prostheses from physicians in these settings are submitted to the applicable A/B MAC."
Added: "Physicians who are enrolled as a DMEPOS supplier are to submit claims for eye prostheses provided in an office or nursing home setting by nonphysicians or physicians to the DME MAC."
MODIFIERS
Added: "MODIFIERS" section and right (RT) and/or left (LT) modifier information
CODING GUIDELINES
Removed: Right (RT) and/or left (LT) modifier information

03/21/2024: 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.

Facial Prostheses

PA

Revision Effective Date: 01/01/2020
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES
Removed: "Claims for facial prostheses from nonphysicians provided in an office or nursing home setting are submitted to the DME MAC. Claims for facial prostheses from physicians in these settings are submitted to the local carrier."
Added: "Physicians who are enrolled as a DMEPOS supplier are to submit claims for eye prostheses provided in an office or nursing home setting by nonphysicians or physicians to the DME MAC."
Revised: "local intermediary" to "applicable A/B MAC"
Removed: "Implanted prosthesis anchoring components should not be billed to the DME MAC." due to redundancy

03/21/2024: 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.

Oxygen and Oxygen Equipment

PA

Revision Effective Date: 04/01/2023
CODING INFORMATION:
Added: "For all claims submitted with the N3 modifier." to Group 1 Paragraph for ICD-10 Codes that DO NOT Support Medical Necessity
Added: ICD-10 codes J96.01, J96.11, J96.21, J96.91, R09.02 to Group 1 ICD-10-CM Codes that DO NOT Support Medical Necessity

03/21/2024: 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.