LCD and Policy Article Revisions Summary for October 12, 2023

Outlined below are the principal changes to the DME MAC Local Coverage Determination (LCD) and Policy Articles (PAs) that have been revised and posted. The policies included are Manual Wheelchair Bases, Power Mobility Devices, Urological Supplies, Wheelchair Options/Accessories, and Wheelchair Seating. Please review the entire LCDs and related PAs for complete information.

Manual Wheelchair Bases

PA

Revision Effective Date: 10/12/2023
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: Information pertaining to the specialty evaluation
Added: “If the supplier is owned by a hospital, the PT, OT, or practitioner working in the inpatient or outpatient hospital setting may perform the specialty evaluation.”

10/12/2023: 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.

Power Mobility Devices

PA

Revision Effective Date: 05/16/2023
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: Information pertaining to the specialty evaluation

10/12/2023: 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.

Urological Supplies

LCD

Revision Effective Date: 10/01/2023
HCPCS CODES:
Revised: Description of HCPCS code A4344 to “INDWELLING CATHETER, FOLEY TYPE, TWO-WAY, ALL SILICONE OR POLYURETHANE, EACH”

10/12/2023: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates per CMS HCPCS coding determinations.

Wheelchair Options/Accessories

PA

Revision Effective Date: 10/12/2023
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: Information pertaining to the specialty evaluation
Added: “If the supplier is owned by a hospital, the PT, OT, or practitioner working in the inpatient or outpatient hospital setting may perform the specialty evaluation.”

10/12/2023: 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.

Wheelchair Seating

PA

Revision Effective Date: 10/12/2023
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: Information pertaining to the specialty evaluation
Added: “If the supplier is owned by a hospital, the PT, OT, or practitioner working in the inpatient or outpatient hospital setting may perform the specialty evaluation.”
ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY:
Added: “E0955” to Group 2 Paragraph and Group 3 Paragraph
Added: Information pertaining to the diagnosis code requirements for E0955
ICD-10-CM CODES THAT DO NOT SUPPORT MEDICAL NECESSITY:
Added: “Exception: For HCPCS code E0955, the ICD-10-CM codes specified in the preceding section are not an exhaustive list. See Group 2 and Group 3 in the preceding section, for additional information.” to Group 1 Paragraph
Removed: “E0955” from language that noted “There are no specified ICD-10 codes”

10/12/2023: 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.

 

Last Updated Oct 12 , 2023