LCD and Policy Article Revisions Summary for June 11 2015 - Revised - JA DME

This article was originally published on June 11, 2015, and is revised to reflect the removal of the future Surgical Dressings Local Coverage Determination and Policy Article.

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

Facial Prosthesis
LCD
Revision Effective Date: 08/01/2015
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Revised: Standard Documentation Language to add covered prior to a beneficiary's Medicare eligibility
DOCUMENTATION REQUIREMENTS:
Deleted: Reference to refill of supplies from Continued Use
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
Revised: Repair to beneficiary-owned DMEPOS
(Note: Standard Documentation Language updates noted above are effective for DOS on or after 10/31/2014)
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: Language for HCPCS Codes A4450, A4452, A5120 when submitted without correct modifier

Policy Article
Revision Effective Date: 08/01/2015
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Revised: Language for HCPCS codes A4450, A4452, A5120 that are billed without correct modifier

Ostomy Supplies
LCD
Revision Effective Date: 08/01/2015
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Revised: Standard Documentation Language to add covered prior to a beneficiary's Medicare eligibility
DOCUMENTATION REQUIREMENTS:
Removed: ICD-9 references
Revised: Standard Documentation Language to add who can enter date of delivery date on the POD
(Note: The effective date above is not applicable to this section. These revised and added requirements are existing Medicare requirements which are now included in the LCD for easy reference)
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: Language for HCPCS codes A4450, A4452 and A5120 when submitted without correct modifier

Policy Article
Revision Effective Date: 08/01/2015
Non-Medical Necessity Coverage and Payment Rules:
Removed: ICD-9 references
Revised: Language for HCPCS codes A4450, A4452, A5120 when submitted without correct modifier

Tracheostomy Care Supplies
LCD
Revision Effective Date: 08/01/2015
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Revised: Standard Documentation Language to add covered prior to a beneficiary's Medicare eligibility
DOCUMENTATION REQUIREMENTS:
Revised: Standard Documentation Language to add who can enter date of delivery date on the POD
(Note: Standard Documentation Language updates noted above are effective for DOS on or after 10/31/2014)
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Removed: ICD-9 references
Added: Language for HCPCS codes A4450, A4452, A5120 when submitted without correct modifier

Policy Article
Revision Effective Date: 08/01/2015
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Revised: Language for HCPCS codes A4450, A4452, A5120 when submitted without correct modifier

Urological Supplies
LCD
Revision Effective Date: 08/01/2015
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Revised: Standard Documentation Language to add covered prior to a beneficiary's Medicare eligibility
DOCUMENTATION REQUIREMENTS:
Revised: Standard Documentation Language to add who can enter date of delivery date on the POD
(Note: Standard Documentation Language updates noted above are effective for DOS on or after 10/31/2014)
Added:  Language for HCPCS codes A4217, A4450, A4452 when submitted without correct modifier

Policy Article
Revision Effective Date: 08/01/2015
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Removed: KX modifier reference from this section
Revised: Language for HCPCS codes A4217, A4450, A4452 when submitted without correct modifier

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