Article Detail - JD DME

Outlined below are the principal changes to the DME MAC Policy Articles (PAs) that have been revised and posted. The policies included are Spinal Orthoses: TLSO and LSO and Therapeutic Shoes for Persons with Diabetes. Please review the entire Local Coverage Determinations (LCDs) and related PAs for complete information.

Spinal Orthoses: TLSO and LSO

PA

Revision Effective Date: 07/07/2022
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Revised: “coding guideline” and “Coding Guidelines” to “CODING GUIDELINES” in reference to section
Removed: Statement that pertained to the effective date for coding verification review requirement and to statutory denial
Revised: “CAD-CAM” to “computer-aided design/computer-aided manufacturing (CAD/CAM)”
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Revised: “off-the-shelf” to “OTS”
Revised: “Coding Guidelines” to “CODING GUIDELINES” in reference to section
Removed: Information pertaining to that which suppliers must do when providing these items
CODING GUIDELINES:
Revised: “three point” to “three-point”
Revised: “L codes” to “L-codes”
Removed: Statement that referred to Documentation Requirements section of the LCD for instructions concerning use of the CG modifier
Removed: Statement that pertained to billing when CAD/CAM technology used to fabricate an orthosis
CODING VERIFICATION REVIEW:
Added: Section header and PDAC coding verification review information
Revised: Reference to the coding verification review effective date for HCPCS codes L0455, L0457, L0467, L0469, L0641, L0642, L0643, L0648, L0649, L0650, L0651

07/07/2022: 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:
Removed: Reference of HCPCS codes for inserts and modifications used with L-coded footwear
Added: Language referring to the Orthopedic Footwear LCD and LCD-related Policy Article for more information
Added: Language referring to the Lower Limb Prostheses LCD and LCD-related Policy Article for information pertaining to coverage of devices under the prosthetic devices benefit category

07/07/2022: 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/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