RETIRED - LCD and Policy Article Summary for October 15, 2015 - Drafts Released to Final

IMPORTANT: THIS DOCUMENT CONTAINS OUTDATED INFORMATION.

Content Provided on this page contains outdated information and instruction and should not be considered current. Noridian is providing this archived information for research purposes only. This archived article contains previously issued instructions that have since been updated or are no longer applicable for Medicare billing purposes.

Article retired due to content incorporation into the applicable Local Coverage Determination or related Policy Article.

Draft Pneumatic Compression Devices Local Coverage Determination and Policy Article has been finalized.

The medical policy will be effective for claims with dates of service on or after December 1, 2015. The notice period start date is October 15, 2015, and the notice period end date is November 30, 2015.

Pneumatic Compression Devices
LCD
Revision Effective Date: 12/01/2015
Draft Released to Final
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Added: Explicit statement on E0675 non-coverage
Added: E0676 benefit exclusion reference in related Policy Article
Revised: Requirements for Four-Week Trial for Lymphedema
Revised: Requirements for Six-Month Trial for Chronic Venous Insufficiency
Revised: E0652 requirements
HCPCS CODES AND MODIFIERS:
Added: E0675 and E0676
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS
Revised: Requirements for E0652
Added: E0675 to ACA 6407 requirements table

Policy Article
Revision Effective Date: 12/01/2015
Draft Released to Final
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: Prevention of Venous Thrombolism exclusion from coverage
Added: Statutorily denial language for E0676
Added: E0675 to ACA 6407 requirements table
CODING GUIDELINES:
Added: Coding instructions for Sleeves E0656 and E0657
Added: Coding instructions for E0675
Added: E0675 to the Coding Verification Review

Please review the entire LCD and related Policy Article for coverage, coding and documentation requirements. Also review the Response to Comments Summary attached to the LCD.

 

Last Updated Dec 11 , 2023