Policy Article Revisions Summary for March 20, 2025 - JA DME

Joint DME MAC Publication
Posted on March 20, 2025

Outlined below are the principal changes to the DME MAC Policy Articles (PAs) that have been revised and posted. The policies included are Ostomy Supplies and Urological Supplies. Please review the entire Local Coverage Determinations (LCDs) and related PAs for complete information.

Ostomy Supplies

PA

Revision Effective Date: 01/01/2022
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: "Ostomy supplies are covered for a beneficiary who has a permanent impairment requiring an ostomy. A permanent ostomy is defined as a condition that is not expected to be medically or surgically corrected in that beneficiary. Permanence is a condition that is of a long and indefinite duration. This does not require a determination that there is no possibility that the beneficiary's condition may improve sometime in the future. If the medical record, including the judgment of the treating practitioner, indicates the condition is of long and indefinite duration, the test of permanence is considered met. Ostomy supplies will be denied as non-covered in situations in which it is expected that the condition will be temporary." as clarification

03/20/2025: 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.

Urological Supplies

PA

Revised Effective Date: 04/01/2023
GENERAL:
Removed: "Permanent urinary retention is defined as retention that is not expected to be medically or surgically corrected in that beneficiary within 3 months" and "(ordinarily at least 3 months)" as clarification

03/20/2025: 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.