LCD and Policy Article Revisions Summary for May 19 2016 - JA DME

Outlined below are the principal changes to the Knee Orthoses DME MAC Local Coverage Determination (LCD) and Policy Article (PA) that have been revised and posted. Please review the entire LCD and related PA for complete information.

Knee Orthoses
LCD
Revision Effective Date: 06/02/2016
ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:
Added: HCPCS Codes L1832 and L1833 to Group 2 Diagnoses
Added: Initial, Subsequent, and Sequela ICD-10s to Group 2 and Group 4
Removed: ICD-10 Non-specific femur codes S72.426B & S72.426C – entered in error
DOCUMENTATION REQUIREMENTS:
Revised: Standard Documentation language (Effective 04/28/2016) ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:
Added: HCPCS Codes L1832 and L1833 to Group 2 Diagnoses
Added: Initial, Subsequent, and Sequela ICD-10s to Group 2 and Group 4
Removed: ICD-10 Non-specific femur codes S72.426B & S72.426C – entered in error
DOCUMENTATION REQUIREMENTS:
Revised: Standard Documentation language (Effective 04/28/2016)

Policy Article
Revision Effective Date: 06/02/2016
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: Definitions from CMS DMEPOS Quality Standards (42 CFR 424.57) and 42 CFR 414.402
CODING GUIDELINES:
Added: Custom fabricated orthosis definitions
Added: Definition of K0672

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