LCD and Policy Article Revisions Summary for March 18, 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 Knee Orthoses, Lower Limb Prostheses, Mechanical In-exsufflation Devices, Negative Pressure Wound Therapy Pumps, Pressure Reducing Support Surfaces - Group 1, Pressure Reducing Support Surfaces - Group 2, Pressure Reducing Support Surfaces - Group 3, Surgical Dressings and Therapeutic Shoes for Persons with Diabetes. Please review the entire LCDs and related Policy Articles for complete information.

Knee Orthoses

PA

Revision Effective Date: 02/01/2021
CODING GUIDELINES:
Added: “(CVR)” after reference to coding verification review
Added: “(PCL)” after reference to “Product Classification List”
Revised: Coding verification review information, to include incorrect coding denial language for products billed using HCPCS that require written coding verification review

03/18/2021: 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.

Lower Limb Prostheses

PA

Revision Effective Date: 08/01/2020
CODING GUIDELINES:
Removed: Trademark symbols
Removed: “etc.” from the not all-inclusive list of other components of a prosthesis
Revised: Infinite Socket TT-S information, to include addition HCPCS code L5637
Revised: Coding guidelines for HCPCS codes L5968 and L5986
CODING VERIFICATION REVIEW:
Added: “(PCL)” after reference to “Product Classification List”
Added: Incorrect coding denial language for products billed using HCPCS that require written coding verification review

03/18/2021: 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.

Mechanical In-exsufflation Devices

PA

Revision Effective Date: 10/01/2020
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: Reimbursement statement for replacement of A7020
ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:
Added: A7020 to Group 1 Paragraph

03/18/2021: 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.

Negative Pressure Wound Therapy Pumps

LCD

Revision Effective Date: 05/01/2021
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Revised: Roman to Arabic numerals in staging scheme
Revised: “an” to “a” before NPWT
APPENDICES:
Revised: Updated National Pressure Ulcer Advisory Panel to National Pressure Injury Advisory Panel and 2019 guidelines (unchanged from 2016 guidelines)

03/18/2021: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due grammatical or non-substantive changes.

PA

Revision Effective Date: 01/01/2020
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Revised: “an” to “a” before NPWT
MODIFIERS:
Revised: "an” to “a” before NPWT

03/18/2021: 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.

Pressure Reducing Support Surfaces - Group 1

LCD

Revision Effective Date: 05/01/2021
APPENDICES:
Revised: National Pressure Ulcer Advisory Panel to National Pressure Injury Advisory Panel and 2019 guidelines (unchanged from 2016 guidelines)

03/18/2021: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due grammatical or non-substantive changes.

PA

Revision Effective Date: 05/01/2021
RELATED CLINICAL INFORMATION:
Revised: Roman to Arabic numerals in staging scheme
03/18/2021: 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.

Pressure Reducing Support Surfaces - Group 2

LCD

Revision Effective Date: 05/01/2021
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Revised: Spelling error from ‘appropriatge’ to ‘appropriate’
Revised: Roman to Arabic numerals in staging scheme
APPENDICES:
Revised: National Pressure Ulcer Advisory Panel to National Pressure Injury Advisory Panel and 2019 guidelines (unchanged from 2016 guidelines)

03/18/2021: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due grammatical or non-substantive changes.

PA

Revision Effective Date: 01/01/2020
CODING GUIDELINES:
Added: “(CVR)” after reference to coding verification review
Added: “(PCL)” after reference to “Product Classification List”
Revised: Coding verification review information, to include incorrect coding denial language for products billed using HCPCS that require written coding verification review

03/18/2021: 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.

Pressure Reducing Support Surfaces - Group 3

LCD

Revision Effective Date: 05/01/2021
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Revised: Roman to Arabic numerals in staging scheme
APPENDICES:
Revised: National Pressure Ulcer Advisory Panel to National Pressure Injury Advisory Panel 2019 guidelines (unchanged from 2016 guidelines)

03/18/2021: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due grammatical or non-substantive changes.

PA

Revision Effective Date: 01/01/2020
CODING GUIDELINES:
Added: E0194 includes heavy duty and bariatric devices

03/18/2021: 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.

Surgical Dressings

LCD

Revision Effective Date: 05/01/2021
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Revised: Roman to Arabic numerals in staging scheme
DOCUMENTATION REQUIREMENTS:
Revised: Statement to add in “treating practitioner’s”
APPENDICES:
Revised: National Pressure Ulcer Advisory Panel to National Pressure Injury Advisory Panel and 2019 guidelines (unchanged from 2016 guidelines)

03/18/2021: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due grammatical or non-substantive changes.

PA

Revision Effective Date: 05/01/2021
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Revised: Roman to Arabic numerals in staging scheme
CODING GUIDELINES:
Revised: Roman to Arabic numerals in staging scheme
Added: “(CVR)” after reference to coding verification review
Added: “(PCL)” after reference to “Product Classification List”
Revised: Coding verification review information, to include incorrect coding denial language for products billed using HCPCS that require written coding verification review

03/18/2021: 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.

Therapeutic Shoes for Persons with Diabetes

PA

Revision Effective Date: 11/05/2020
CODING GUIDELINES:
Added: “(PCL)” after reference to “Product Classification List”
Added: Incorrect coding denial language for products billed using HCPCS that require written coding verification review

03/18/2021: 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.

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
  5. Click on hyperlink to go to the policy

 

            Last Updated Thu, 29 Apr 2021 16:54:26 +0000