Policy Article Revisions Summary for May 9, 2024 - JA DME

Joint DME MAC Publication
Posted May 9, 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 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
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: Amikacin liposome noncoverage information
CODING GUIDELINES:
Added: "The nebulizer used to administer amikacin liposome must be coded and billed using HCPCS code A9270, noncovered item or service."

05/09/2024: 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: 11/05/2020
MODIFIERS:
Added: RT and LT modifier information (relocated from the CODING GUIDELINES section)
CODING GUIDELINES:
Removed: RT and LT modifier information
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)

05/09/2024: 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.