Article Detail - JD DME

RETIRED February 2, 2018

Dear Physician, Supplier, Specialty Group:

The Centers for Medicare and Medicaid Services (CMS) assigned to the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) the task of developing local coverage determinations (LCDs) for the purpose of processing and reviewing Medicare claims for Durable Medical Equipment, Prostheses, Orthoses, and Supplies (DMEPOS). The DME MACs are proposing revisions to three LCDs: Automatic External Defibrillators, Pneumatic Compression Devices, and Suction Pumps.

These three LCDs are revisions to existing LCDs; therefore, not all of the material in each policy is new. The major revisions are summarized below; however, each LCD should be completely reviewed in the preparation of comments.

Automatic External Defibrillator LCD changes

• Revised coverage criteria for wearable (K0606) and non-wearable (E0617) defibrillators
• Added definition for myocardial infarction to maintain consistency with national coverage determination for implantable defibrillators
• Revised covered diagnosis code list

Pneumatic Compression Devices (PCD) LCD changes

• Added coverage for peripheral arterial disease using arterial insufficiency devices (E0675)
• Revised coverage criteria for PCDs E0650, E0651 and E0652

Suction Pumps LCD changes

• Added not reasonable and necessary statement for wound suction pumps (K0743) and related supplies (K0744-K0746)
• Added coverage criteria for gastric suction (E2000)

We are soliciting comments on these draft policies from physicians, manufacturers, suppliers and other professionals involved in the ordering or provision of these items. We recommend that you distribute these draft policies to selected members of your organization for review and comment. If you disagree with any aspect of a policy, you should be very specific in your comment and, if possible, offer an alternative. You should provide a clinical rationale for your position including references from the published clinical literature (e.g. standard textbooks, peer-reviewed journals, etc.). We encourage a written response if you agree with this policy. If you are providing comments on more than one LCD, please provide separate comments for each policy with the policy indicated in the subject line of the submission.

All comments will be collected at a single point of contact. Please submit your comments electronically to the DME MAC medical directors at the e-mail address below no later than September 23, 2011. Comments may also be submitted hardcopy although e-mail is preferred.

Paul J. Hughes, MD
Medical Director, DME MAC, Jurisdiction A
NHIC, Corp
75 Sgt. William B. Terry Drive
Hingham, MA 02043
nhicdmedraftLCDfeedback@hp.com

A joint DME MAC public meeting will be held on August 30, 2011 in Baltimore, MD. Interested parties from any DME MAC jurisdiction may attend this public meeting. This meeting is for oral presentations only. Meeting minutes are not taken and there is no Question and Answer component to the meeting. In order for comments to be considered, they must be presented in writing through the formal comment process. Advance registration is required. Information regarding this meeting will be posted in the near future on each DME MAC web site.

When all comments have been received, they will be reviewed and revisions will be considered. The final policies will be published in the CMS Medicare Coverage Database and on individual DME MAC web sites, allowing for adequate notice before the policies' effective date.

Thank you for your participation in our policy revision process.

Sincerely,
Paul J. Hughes, MD

On behalf of:

Paul J. Hughes, M.D.
Medical Director, DME MAC, Jurisdiction A
NHIC, Corp.

Stacey V. Brennan, M.D., FAAFP
Medical Director, DME MAC, Jurisdiction B
National Government Services

Robert D. Hoover, Jr., MD, MPH, FACP
Medical Director, DME MAC, Jurisdiction C
CGS Administrators, LLC

Richard W. Whitten, MD, MBA, FACP
Medical Director, DME MAC, Jurisdiction D
Noridian Administrative Services