LCD and Policy Article Revisions Summary for December 30, 2021

Outlined below are the principal changes to the DME MAC Local Coverage Determinations (LCDs) and Policy Articles (PAs) that have been revised and posted. The policies included are Bowel Management Devices, Ostomy Supplies and Standard Documentation Requirements for All Claims Submitted to DME MACs. Please review the entire LCDs and related PAs for complete information.

Bowel Management Devices

LCD

Revision Effective Date: 10/01/2021
CODING INFORMATION:
Added: HCPCS code A4453, due to quarterly HCPCS code release

12/30/2021: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates to CMS HCPCS coding determinations.

PA

Revision Effective Date: 10/01/2021
CODING GUIDELINES:
Revised: A4459 coding guideline information, to clarify all-inclusive at initial issue
Added: A4453 billing direction, for use when billing disposable catheter refills

12/30/2021: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Ostomy Supplies

LCD

Revision Effective Date: 01/01/2022
COVERAGE INDICATIONS, INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Removed: HCPCS code A4397 from Usual Maximum Quantity of Supplies table
Added: HCPCS codes A4436 and A4437 to Usual Maximum Quantity of Supplies table
CODING INFORMATION:
Removed: HCPCS code A4397 from Group 1 Codes (invalid code on or after DOS 01/01/2022)
Added: HCPCS codes A4436 and A4437 to Group 1 Codes (valid on or after DOS 01/01/2022)

12/30/2021: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates per CMS HCPCS coding determinations.

PA

Revision Effective Date: 01/01/2022
CODING GUIDELINES:
Added: Billing direction regarding codes A4436 and A4437 (valid for billing on or after DOS 01/01/2022)
Removed: Code A4397 (invalid for billing on or after DOS 01/01/2022)

12/30/2021: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Standard Documentation Requirements for All Claims Submitted to DME MACs

PA

Revision Effective Date: 04/06/2020
DOCUMENTATION REQUIREMENTS:
Added: Statement regarding exceptions to ongoing justification for continued medical need

12/30/2021: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination. This revision is non-substantive.

Note: The information contained in this article is only a summary of revisions to the LCDs and PAs. For complete information on any topic, you must review the LCDs and/or PAs.
With the update(s) listed above, Noridian would like to remind users how to find the policy that was previously effective. When billing, the supplier should follow guidance that was effective on the date of service. The below steps can be followed to find all previous policies:

  1. Open the currently effective policy on the Medical Coverage Database (MCD)
    1. Links to the MCD can be found on the Active LCDs page on the Noridian website
      1. There is a link at the top of the Active LCD page that goes to a full list of the LCDs or PAs, depending on which link is selected OR
      2. There are direct links to all LCDs under the ‘LCD ID number and Effective Date’ column
  2. Scroll down to the bottom of the policy
  3. Find the section labeled Public Version(s)
  4. Look for the link to the policy that was effective on the dates of service in question

Click on hyperlink to go to the policy

 

            Last Updated Thu, 30 Dec 2021 14:35:41 +0000