LCD and Policy Article Revisions Summary for February 19 2015 - JA DME
LCD and Policy Article Revisions Summary for February 19, 2015
Outlined below are the principal changes to a DME MAC Local Coverage Determinations (LCD) and a Policy Article (PA) that have been revised and posted. Please review the entire LCD and each related PA for complete information.
External Infusion Pumps
LCD
Revision Effective Date: 01/01/2015
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Added: Coverage for Levodopa-Carbidopa enteral suspension (effective for dates of service on or after 01/09/2015)
Added: Coverage for Blinatumomab (effective for dates of service on or after 12/03/2014)
Revised: Standard Documentation Language to add covered prior to a beneficiary's Medicare eligibility
HCPCS CODES AND MODIFIERS:
Added: Codes A4602 and J2274
Deleted: Codes J2271 and J2275
ICD-9 CODES THAT SUPPORT MEDICAL NECESSITY:
Group 4 Paragraph:
Added: HCPCS Code for Levodopa-Carbidopa enteral suspension
Group 4 Codes:
Added: ICD-9 Code 332.0
Group 5 Paragraph:
Added: HCPCS Code for Blinatumomab
Group 5 Codes:
Added: ICD-9 Code 204.02
DOCUMENTATION REQUIREMENTS:
Revised: Standard Documentation Language to add who can enter date of delivery date on the POD
Added: Instructions for equipment retained from a prior payer
Added: Repair /Replacement section
Policy Article
Revision Effective Date: 01/01/2015
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Removed: "When required by state law" from ACA new prescription requirements
Revised: Face-to-Face Requirements for treating practitioner
CODING GUIDELINES:
Added: Coding requirements for lithium batteries
Deleted: References to codes J2271 and J2275
Added: Levodopa-Carbidopa enteral suspension (effective for dates of service on or after 01/09/2015) Added: Blinatumomab (effective for dates of service on or after 12/03/2014)
Note: The information contained in this article is only a summary of revisions to the LCD and Policy Article. For complete information on any topic, you must review the LCD and/or Policy Article.