RETIRED - Parenteral Nutrition - Least Costly Medically Appropriate Alternative Eliminated

IMPORTANT: THIS DOCUMENT CONTAINS OUTDATED INFORMATION.Content Provided on this page contains outdated information and instruction and should not be considered current.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 This archived article contains previously issued instructions that have since been updated or are no longer applicable for Medicare billing purposes.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.

Posted January 27, 2011

CMS has instructed contractors that they may no longer make partial payment for claims based on a "least costly alternative" (LCA) determination. In December 2010, the DME MACs released revisions to LCDs containing LCA provisions. The Parenteral Nutrition LCD was not included in that release.

It was discovered that the Parenteral Nutrition LCD might be considered as having an LCA provision. The Parenteral Nutrition LCD contains the following statement:

"Special parenteral formulas (B5000-B5200) are rarely medically necessary. If the medical necessity for these formulas is not substantiated, payment will be made for the medically appropriate formula."

While this passage does not explicitly say "paid at LCA", in most cases the medically appropriate formula is a standard nutrient solution which is less costly. Therefore, it was felt that it would be appropriate to revise the passage. The revised section states:

"The medical necessity for special parenteral formulas (B5000-B5200) must be justified in each patient. If a special parenteral nutrition formula is provided and if the medical record does not document why that item is reasonable and necessary, it will be denied as not reasonable and necessary."

A revised LCD will be released via our list-serves. The revised LCD will be effective for dates of service on or after 2/4/2011.

 

            Last Updated Thu, 10 Jan 2019 12:49:17 +0000