LCD and Policy Article Revisions Summary for March 13 2014 - JA DME

Outlined below are the principal changes to DME MAC Local Coverage Determinations (LCDs) and a Policy Articles (PA) that have been revised and posted. Please review the entire LCD and each related PA for complete information.

Glucose Monitors

LCD

Revision Effective Date:  01/01/2014

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

Added:  Information that item(s) in policy are subject to ACA 6407 requirements (effective 07/01/2013)

Revised: Specific ICD-9 diagnosis codes contained in the narrative are replaced with a reference to the applicable diagnosis code tables

ICD-9 CODES THAT SUPPORT MEDICAL NECESSITY:

Added:  Gestational diabetes (648.00-648.04)

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

Added: ACA 6407 information (requirements effective 07/01/2013)

Policy Article:

Revision Effective Date: 01/01/2014 (March 2014 Publication)

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

Added: ACA 6407 requirements (requirements effective 07/01/13)

High Frequency Chest Wall Oscillation Devices

LCD

Revision Effective Date: 11/01/2013 (March 2014 Publication)

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

Added:  Information that item(s) in policy are subject to ACA 6407 requirements (effective 07/01/2013)

Revised: Specific ICD-9 diagnosis codes contained in the narrative are replaced with a reference to the applicable diagnosis code tables
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

Added: ACA 6407 information (requirements effective 07/01/2013)

Policy Article

Revision Effective Date: 11/01/2013 (March 2014 Publication)

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: ACA 6407 requirements (requirements effective 07/01/13)

Immunosuppressive Drugs

LCD
Revision Effective Date: 01/01/2014

HCPCS CODES AND MODIFIERS:

Added: J7508

Revised: J7507 narrative description

Nebulizers

LCD

Revision Effective Date: 11/01/2013 (March 2014 Publication)

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

Added:  Information that item(s) in policy are subject to ACA 6407 requirements (effective 07/01/2013)

Revised: Specific ICD-9 diagnosis codes contained in the narrative are replaced with a reference to the applicable diagnosis code tables

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

Added: ACA 6407 information (requirements effective 07/01/2013)

Policy Article

Revision Effective Date: 11/01/2013 (March 2014 Publication)

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

Added: ACA 6407 requirements (effective 07/01/2013)

Negative Pressure Wound Therapy Pumps

LCD

Revision Effective Date: 11/01/2013 (March 2014 Publication)

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

Added:  Information that item(s) in policy are subject to ACA 6407 requirements (effective 07/01/2013)

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

Added: ACA 6407 information (requirements effective 07/01/13)

Policy Article

Revision Effective Date: 11/01/2013 (March 2014 Publication)

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

Added: ACA 6407 requirements (effective 07/01/2013)

Orthopedic Footwear

LCD

Revision Effective Date: 01/01/2014

HCPCS CODES AND MODIFIERS:

Revised: L3100 and L3170 narrative description

Oxygen and Oxygen Equipment

LCD
Revision Effective Date: 01/01/2014

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

Added: Statement about bundled payment category

Added: Additional clarification about concurrent use of oxygen in OSA testing

Added:  Information that item(s) in policy are subject to ACA 6407 requirements (effective 07/01/2013)

HCPCS CODES AND MODIFIERS:

Added: E1352

DOCUMENTATION REQUIREMENTS:

Added: ACA 6407 information (requirements effective 07/01/2013)

Policy Article

Revision Effective Date: 01/01/2014

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

Added: Clarification about separate billing for stationary and portable contents

Added ACA 6407 material (effective 07/01/2013)

CODING GUIDELINES:

Added: E1352

Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea

LCD

Revision Effective Date: 01/01/2014 (March 2014 Publication)

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

Added:  Information that item(s) in policy are subject to ACA 6407 requirements effective 07/01/2013)

HCPCS CODES AND MODIFIERS:

Revised:  Narrative of code E0601

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

Added: ACA 6407 information (requirements effective 07/01/2013)

Policy Article

Revision Effective Date: 11/01/2013 (March 2014 Publication)

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

Added: ACA 6407 requirements (effective 07/01/2013)

Wheelchair Options/Accessories
LCD

Revision Effective Date: 11/01/2013 (March 2014 Publication)
 

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

Added:  Information that item(s) in policy are subject to ACA 6407 requirements (effective 07/01/2013)

HCPCS CODES AND MODIFIERS:

Revised: HCPCS Narrative of E2300 and E2301

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

Added: ACA 6407 information (requirements effective 07/01/2013)

Policy Article

Revision Effective Date: 11/01/2013 (March 2014 Publication)

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

Added: ACA 6407 requirements (effective 07/01/2013)

Revised: Restored K0077 to Manual Wheelchair Base, Power Wheelchair Base Groups 1 and 2 and Power Wheelchair Base Groups 3, 4 and 5 Column II of the bundling table

Note: The information contained in this article is only a summary of revisions to LCDs and Policy Articles. For complete information on any topic, you must review the LCD and/or Policy Article.