LCD and Policy Article Revisions Summary for June 11, 2020

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

Urological Supplies

LCD

Revision Effective Date: 07/26/2020
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Revised: Format of HCPCS code references, from code ‘spans’ to individually-listed
Added: Billing and coverage information for the inFlow device (HCPCS Code A4335)
Removed: Denial statement for inFlow device (A4335)
GENERAL:
Added: References to Standard Written Order (SWO)
REFILL REQUIREMENTS:
Revised: “ordering physicians” to “treating practitioners”
SUMMARY OF EVIDENCE:
Added: Information related to inFlow device
ANALYSIS OF EVIDENCE:
Added: Information related to inFlow device
CODING INFORMATION:
Removed: Field titled “Bill Type” Removed: Field titled “Revenue Codes”

Removed: Field titled “ICD-10 Codes that Support Medical Necessity”
Removed: Field titled “ICD-10 Codes that DO NOT Support Medical Necessity”
Removed: Field titled “Additional ICD-10 Information”
DOCUMENTATION REQUIREMENTS:
Revised: “physician’s” to “practitioner’s”
GENERAL DOCUMENTATION REQUIREMENTS:
Revised: “Prescriptions (orders)” to “SWO”
BIBLIOGRAPHY:
Added: Section related to inFlow device
RELATED LOCAL COVERAGE DOCUMENTS:
Added: Response to Comments (A58231)

PA

Revision Effective Date: 07/26/2020
REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 Fed. Reg Vol 217):
Added: Section and related information based on Final Rule 1713
GENERAL:
Revised: Billing direction for inFlow and urological supplies when inserted or used in a practitioner’s office
Revised: “physician” updated to “treating practitioner”
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: Directional statement regarding practitioner as supplier
Added: Continued medical need language
MODIFIER:
Added: inFlow device to KX modifier directions
MISCELLANEOUS:
Revised: Format of HCPCS code references, from code ‘spans’ to individually-listed
CODING GUIDELINES:
Revised: Format of HCPCS code references, from code ‘spans’ to individually-listed
Revised: inFlow device statement to replace battery and/or wand with “activator”
ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:
Revised: Section header “ICD-10 Codes that are Covered” updated to “ICD-10 Codes that Support Medical Necessity”
ICD-10 CODES THAT DO NOT SUPPORT MEDICAL NECESSITY:
Revised: Section header “ICD-10 Codes that are Not Covered” updated to “ICD-10 Codes that DO NOT Support Medical Necessity”

06/11/2020: 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

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 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
  5. Click on hyperlink to go to the policy

 

            Last Updated Thu, 11 Jun 2020 15:55:41 +0000