Article Detail - JD DME

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 Intravenous Immune Globulin. Please review the entire LCD and related PA for complete information.

Intravenous Immune Globulin

LCD

Revision Effective Date: 01/01/2024
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Removed: Denial statement regarding IVIG used with an infusion pump
HCPCS CODES:
Added: Q2052 (in Group 1 Paragraph text)

11/30/2023: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates per CMS Final Rule CMS-1780-F.

PA

Revision Effective Date: 01/01/2024
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: Services, supplies and accessories to noncovered statement when statutory criteria not met
Removed: Statement to refer to the LCD when IVIG administered with an infusion pump and statutory criteria not met
Removed: Statement regarding IVIG benefit limited to IVIG itself
Added: Services, supplies and accessories are billed with HCPCS code Q2052 and only one unit of service shall be paid per infusion date of service
CODING GUIDELINES:
Removed: Use of HCPCS code A4223 instructions when IVIG not administered with an infusion pump
Removed: Reference to the External Infusion Pump LCD and Policy Article when IVIG is administered with an infusion pump
Added: Coding instructions for Q2052

11/30/2023: 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.

Note: The information contained in this article is only a summary of revisions to the LCDs and/or 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.