Outlined below are the principal changes to the DME MAC Policy Articles (PAs) that have been revised and posted. The policies included are Oxygen and Oxygen Equipment, Nebulizers, Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea, High Frequency Chest Wall Oscillation Devices, Mechanical In-exsufflation Devices, Oral Appliances for Obstructive Sleep Apnea, Respiratory Assist Devices, and Suction Pumps. Please review the entire Local Coverage Determinations (LCDs) and related PAs for complete information.

High Frequency Chest Wall Oscillation Devices

PA

Revision Effective Date: 10/01/2021
CODING GUIDELINES:
Revised: Coding instructions for multifunction ventilators (E0467) (Effective 01/01/2019)
CODING VERIFICATION REVIEW:
Added: Section header and PDAC coding verification review (CVR) information
Added: CVR requirement for products coded E0467

11/11/2021: 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.

Mechanical In-exsufflation Devices

PA

Revision Effective Date: 10/01/2021
CODING GUIDELINES:
Revised: Coding instructions for multifunction ventilators (E0467) (Effective 01/01/2019)
CODING VERIFICATION REVIEW:
Added: Section header and PDAC coding verification review (CVR) information
Added: CVR requirement for products coded E0467

11/11/2021: 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.

Nebulizers

PA

Revision Effective Date: 05/17/2020
CODING GUIDELINES:
Revised: Coding instructions for multifunction ventilators (E0467) (Effective 01/01/2019)
CODING VERIFICATION REVIEW:
Added: Section header and PDAC coding verification review (CVR) information
Added: CVR requirement for products coded E0467

11/11/2021: 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.

Oral Appliances for Obstructive Sleep Apnea

PA

Revision Effective Date: 08/08/2021
CODING GUIDELINES:
Moved: E0486 code verification review (CVR) language to coding verification review section
Revised: Coding instructions for multifunction ventilators (E0467) (Effective 01/01/2019)
CODING VERIFICATION REVIEW:
Added: Section header and PDAC CVR information
Added: CVR requirement for products coded E0486 and E0467

11/11/2021: 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.

Oxygen and Oxygen Equipment

PA

Revision Effective Date: 08/02/2020
CODING GUIDELINES:
Moved: E1405 and E1406 coding verification review (CVR) language to coding verification review section
Revised: Coding instructions for multifunction ventilators (E0467) (Effective 01/01/2019)
CODING VERIFICATION REVIEW:
Added: Section header and PDAC CVR information
Added: CVR requirement for products coded E1405, E1406 and E0467

11/11/2021: 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.

Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea

PA

Revision Effective Date: 08/08/2021
CODING GUIDELINES:
Revised: Coding instructions for multifunction ventilators (E0467) (Effective 01/01/2019)
CODING VERIFICATION REVIEW:
Added: Section header and PDAC coding verification review (CVR) information
Added: CVR requirement for products coded E0467

11/11/2021: 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.

Respiratory Assist Devices

PA

Revision Effective Date: 08/08/2021
CODING GUIDELINES:
Revised: Coding instructions for multifunction ventilators (E0467) (Effective 01/01/2019)
CODING VERIFICATION REVIEW:
Added: Section header and PDAC coding verification review (CVR) information
Added: CVR requirement for products coded E0467.

11/11/2021: 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.

Suction Pumps

PA

Revision Effective Date: 08/15/2021
CODING GUIDELINES:
Moved: K0743 coding verification review (CVR) language to coding verification review section
Revised: Coding instructions for multifunction ventilators (E0467) (Effective 01/01/2019)
CODING VERIFICATION REVIEW:
Added: Section header and PDAC CVR information
Added: CVR requirement for products coded K0743 and E0467

11/11/2021: 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 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