LCD and Policy Article Revisions Summary for October 2, 2025 - JA DME

Joint DME MAC Publication
Posted October 2, 2025

Outlined below are the principal changes to the DME MAC Local Coverage Determination (LCD) and Policy Article (PA) that have been revised and posted. The policy included is Wheelchair Seating. Please review the entire LCD and PA for complete information.

Wheelchair Seating

LCD

Revision Effective Date: 10/01/2025
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Removed: "as reflected in a diagnosis code listed in Group 1 of the ICD-10 code list in the LCD-related Policy Article" and "as reflected in a diagnosis code listed in Group 2 of the ICD-10 code list in the LCD-related Policy Article" from the skin protection seat cushion coverage criteria language
Removed: "that are due to one of the following (a or b):," "a. A diagnosis code listed in Group 2 of the ICD-10 code list in the LCD-related Policy Article; or," and "b. A diagnosis code listed in Group 3 of the ICD-10 code list in the LCD-related Policy Article" from the positioning seat cushion, positioning back cushion, and positioning accessory coverage criteria language
Removed: "(Note special instructions for a combination skin protection and positioning cushion in the ICD-10 code list in the LCD-related Policy Article.)"

10/02/2025: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-substantive updates.

PA

Revision Effective Date: 10/01/2025
MODIFIERS:
Removed: "(refer to the Group 1 codes in the ICD-10 code list section)" and "due to one of the diagnoses listed as a covered diagnosis in the Group 2 ICD-10 code list section" from the language that notes when a KX modifier must be added to a skin protection seat cushion code
Removed: "due to one of the diagnoses listed as a covered diagnosis in Group 2 or Group 3 of the ICD-10 code list section" from the language that notes when a KX modifier must be added to a positioning seat cushion, positioning back cushion, or positioning accessory code
Removed: "(refer to the Group 1 codes in the ICD-10 code list section)," "due to one of the diagnoses listed as a covered diagnosis for skin protection cushions (refer to the Group 2 codes in the ICD-10 code list section)," "due one of the diagnoses listed as a covered diagnosis for skin protection cushions (refer to the Group 2 codes in the ICD-10 code list section)," and "due to one of the diagnoses listed as a covered diagnosis for positioning cushions (refer to the Group 2 and Group 3 codes in the ICD-10 code list section)" from the language that notes when a KX modifier must be added to a combination skin protection and positioning seat cushion code
Removed: "due to one of the diagnoses listed as a covered diagnosis for skin protection cushions (refer to the ICD-10 code list section)" and "due to one of the diagnoses listed as a covered diagnosis for positioning cushions (refer to the ICD-10 code list section)" from the language that notes when a KX modifier must be added to a custom fabricated seat or back cushion code
ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY:
Removed: Group 1 Paragraph, Group 2 Paragraph, Group 3 Paragraph, and Group 4 Paragraph
Removed: Group 1 Codes, Group 2 Codes, Group 3 Codes, and Group 4 Codes
Added: "N/A"
ICD-10-CM CODES THAT DO NOT SUPPORT MEDICAL NECESSITY:
Removed: Group 1 Paragraph
Removed: Group 1 Codes information
Added: "N/A"

10/02/2025: 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.