Policy Article Revision Summary for January 23, 2025 - JA DME

Joint DME MAC Publication
Posted on January 30, 2025

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, High Frequency Chest Wall Oscillation Devices and Mechanical In-exsufflation Devices. Please review the entire Local Coverage Determinations (LCDs) and related PAs for complete information.

External Infusion Pumps

PA

Revision Effective Date: 01/23/2025
CODING GUIDELINES:
Revised: Code K0552 to indicate use with HCPCS codes K0455, E0779, E0780, E0781 or E0791 when used to administer a drug utilizing a syringe-type reservoir.
Revised: "The reservoir may be either glass or plastic and includes the needle for drawing up the drug." to "The reservoir may be either glass or plastic and includes the needle or equivalent for drawing up or transferring the drug to the reservoir."
Revised: Table in the HCPCS Supply Codes Associated with External Infusion Pumps HCPCS Codes section by removing "K0552" from the Non-Associated Codes column in the rows pertaining to E0780, E0781, and E0791, and by adding "K0552" to the Associated Codes column in the rows pertaining to E0780, E0781, and E0791
Revised: Statement under table "*For E0779 and K0455 pumps, either A4222 or K0552 may be billed, but not both." to "*For E0779, E0780, E0781, E0791 and K0455 pumps, either A4222 or K0552 may be billed, but not both."

01/23/2025: 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.

High Frequency Chest Wall Oscillation Devices

PA

Revision Effective Date: 01/23/2025
ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY:
Removed: ICD-10-CM codes D81.810, D81.82, and D84.1 from Group 1 Codes
Added: ICD-10-CM codes G70.00 and G70.01 to Group 1 Codes

01/23/2025: 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.

Mechanical In-exsufflation Devices

PA

Revision Effective Date: 01/23/2025
ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY:
Added: ICD-10-CM codes G70.00, G72.49 and G72.9 to Group 1 Codes

01/23/2025: 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.