Medical Director Articles - 2019

 
Title Brief Description Last Updated
Open Meeting Announcement - Oxygen & Oxygen Equipment (DL33797), Nebulizers (DL33370) and External Infusion Pumps (DL33794) This article announces the Open Meeting for the following policies: Oxygen and Oxygen Equipment, Nebulizers, and External Infusion Pumps 12/26/19
RETIRED - 2020 HCPCS Code Annual Update - Correct Coding This article identifies changes to Level II Healthcare Common Procedure Coding System (HCPCS) codes for 2020. 12/18/19
RETIRED - Endoskeletal Prosthetic Knee-Shin Systems - Correct Coding This correct coding article reminds DMEPOS suppliers which HCPCS L-codes are available to fully describe the prosthetic knee-shin system incorporated into the prosthetic limb. 12/18/19
Topical Oxygen Therapy Contractor Advisory Committee (CAC) Key Questions View the key questions discussed by the contractor advisory committee members regarding topical oxygen therapy on October 29, 2019. 12/04/19
Topical Oxygen Therapy CAC Meeting Transcript View the transcript to the Oxygen and Oxygen Equipment Contractor Advisory Committee meeting held on October 29, 2019. 12/04/19
Contractor Advisory Committee (CAC) Members for Topical Oxygen Treatment (TOT) View the topical oxygen therapy contractor advisory committee members involved in the October 29, 2019 meeting. 12/04/19
RETIRED - LIM Innovation Infinite Socket - Correct Coding - Revised Revised correct coding article for the LIM innovation infinite socket. 11/21/19
RETIRED - Panzyga® (Immunoglobulin Intravenous (Human), 10%) Correct Coding and Coverage - Revised This is a revised article to Panzyga® which is covered for claims with dates of service on or after August 2, 2018 when the criteria discussed are met. 11/21/19
Topical Oxygen Therapy Contractor Advisory Committee (CAC) Agenda - October 29, 2019 View the 10/29/19 agenda for TOT CAC Meeting. 10/17/19
RETIRED - Continuous Glucose Monitor Supplies - Correct Coding and Billing View correct coding and billing for supplies associated with the Continuous Glucose Monitors. 10/17/19
Contractor Advisory Committee (CAC) Meeting Information - Oxygen and Oxygen Equipment (L33797) View information on the CAC meeting regarding Oxygen and Oxygen Equipment and requests to add topical oxygen language. 10/10/19
Articulating Digit(s) and Prosthetic Hands - Correct Coding - Revised View correct coding for articulating digit(s) and prosthetic hands. 10/03/19
Functional Electrical Stimulation (FES) - Coverage and HCPCS Coding - Revised This article reviews Medicare coverage of FES for SCI patients who have completed a training program consisting of at least 32 physical therapy sessions with the device, over a period of three months. 09/04/19
Sleep Test Scoring and Medicare Dear Clinician Letter [PDF] For Medicare patients, including those patients entering Medicare from commercial insurance and non-Medicare payers, there must be demonstration that all Medicare coverage criteria are met at the time claims are submitted, including claims for PAP devices and related accessories. 08/28/19
KF Modifier Use Correct Coding This article identifies devices classified by the Food & Drug Administration (FDA) as Class III devices which must be billed using the KF modifier (ITEM DESIGNATED BY FDA AS CLASS III DEVICE). 08/28/19
Partial Hand Prostheses Correct Coding View incorrect coding for partial hand prostheses and provides correct codes for distinct types of amputations including the digit(s) and metacarpal-phalangeal (MCP) joint of missing digit(s). 08/22/19
Medicare Prior Authorization Condition of Payment for Group 2 - Pressure Reducing Support Surfaces Dear Clinician Letter [PDF] Effective for dates of delivery on/after 07/22/19, Medicare will require prior authorization for Group 2 PRSS for the states of California, Indiana, New Jersey, and North Carolina. Effective 10/21/19, this prior authorization expands to the remaining states and territories. 08/01/19
Policy Article Revisions Summary for July 25, 2019 View principal changes to the DME MAC Policy Articles (PA). The policies included are External Infusion Pumps and Intravenous Immune Globulin. 07/25/19
LCD and Policy Article Revisions Summary for July 18, 2019 View the principal changes to the LCD and Policy Article (PA). The policy included is for Tumor Treatment Field Therapy (TTFT). 07/18/19
Tumor Treatment Field Therapy (TTFT) Final LCD (L34823) and Response to Comments (RTC) Article Published This marks the beginning of the 45-day notice period. The final LCD will be effective for claims with dates of service on/after September 1, 2019. 07/18/19
RETIRED - Correct Coding - Definitions Used for Off-the-Shelf versus Custom Fitted Prefabricated Orthotics (Braces) - Revised View off-the-shelf vs custom fitted prefabricated orthotics (braces) definitions and how to decide which code to use. 07/05/19
Policy Article Revisions Summary for July 4, 2019 View the principal changes to the Power Mobility Devices related Policy Article (PA). 07/05/19
New HCPCS Code - Revefenacin (Yupelri®) - J7677 View a new HCPCS code is available for revefenacin (Yupelri®), effective for dates of service on/after July 1, 2019. 06/27/19
Policy Article Revisions Summary for June 13, 2019 View principal changes to the Policy Articles (PA) for Oral Anticancer Drugs and Wheelchair Seating that have been revised and posted. Effective on August 1, 2019. 06/13/19
Tumor Treatment Field Therapy (TTFT) Open Meeting Agenda View the agenda for the TTFT proposed LCD open Meeting on June 20, 2019. 06/04/19
LCD and Policy Article Revisions Summary for May 23, 2019 View principal changes to the DME MAC Local Coverage Determinations (LCDs) and Policy Articles. 05/23/19
Correct Billing – Continued Coverage for Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea This article describes proper use of the KX modifier when a beneficiary fails the initial 12-week trial for positive airway pressure therapy. 05/16/19
Tumor Treatment Field Therapy (DL34823) Proposed LCD Released for Comment The DME MACs are soliciting comments on the proposed TTFT LCD and hosting a public meeting. 05/09/19
Policy Article Revision Summary for April 11, 2019 View principal changes to the DME MAC Local Coverage Determinations (LCDs) and Policy Articles. 04/11/19
RETIRED - Correct Coding and Coverage of Ventilators - Revised April 2019 View information about the application of Medicare proper coding and payment rules for ventilators. 04/04/19
LCD and Policy Article Revisions Summary for April 4, 2019 View principal changes to the DME MAC Local Coverage Determinations (LCDs) and Policy Articles. 04/04/19
LCD and Policy Article Revisions Summary for March 28, 2019 The principal changes to the DME MAC Local Coverage Determinations (LCDs) and Policy Articles that have been revised and posted are outlined. 03/28/19
RETIRED - Correct Coding - Definitions Used for Off-the-Shelf versus Custom Fitted Prefabricated Orthotics (Braces) - Revised As part of the 2014 and 2015 HCPCS update, codes were created describing certain off-the-shelf (OTS) orthotics. Some of these codes parallel codes for custom fitted versions of the same items. See the table at the end of article for a listing of codes. 03/28/19
Policy Article Revisions Summary for March 7, 2019 View the principal changes to the DME MAC Policy Articles (PAs) that have been revised and posted. 03/07/19
Contractor Advisory Committee (CAC) Members for Tumor Treatment Field Therapy View members of the Tumor Treatment Field Therapy (TTFT) Contractor Advisory Committee (CAC). 03/01/19
Tumor Treatment Field Therapy Contractor Advisory Committee Key Questions View the key questions for the Tumor Treatment Field Therapy (TTFT) Contractor Advisory Committee (CAC). 03/01/19
LCD and Policy Article Revisions Summary for February 28, 2019 Revised and posted principal changes to the DME MAC Local Coverage Determinations (LCDs) and Policy Articles 02/28/19
Revised: Billing Reminder - Immunosuppressive Drugs - Delivery to Inpatient Hospitals New rules now allow early delivery of the initial prescriptions of a beneficiary's immunosuppressive drugs to an alternate address, such as the transplant facility or alternative location where the beneficiary is temporarily staying. 02/28/19
Teleconference Information - Tumor Treatment Field Therapy (TTFT) Contractor Advisory Committee Meeting The Tumor Treatment Field Therapy (TTFT) Contractor Advisory Committee Meeting registration is closed, however, interested stakeholders are invited to listen via teleconference or view the meeting via live stream on the CMS YouTube channel. 02/26/19
Tumor Treatment Field Therapy (TTFT) Contractor Advisory Committee (CAC) Agenda The agenda for the Tumor Treatment Field Therapy (TTFT) Contractor Advisory Committee (CAC) meeting can be located here. 02/22/19
LCD and Policy Article Revisions Summary for February 21, 2019 Outlined below are the principal changes to the DME MAC Local Coverage Determinations (LCDs) and Policy Articles that have been revised and posted. 02/21/19
LCD and Policy Article Revisions Summary for February 14, 2019 View the principal revised and posted changes to the DME MAC Local Coverage Determinations (LCDs) and Policy Articles. 02/15/19
Policy Article Revisions Summary for February 7, 2019 Outlined below are the principal changes to the DME MAC Policy Articles (PAs) that have been revised and posted. 01/31/19
RETIRED - Frequently Asked Questions - Temporary Transitional Payment for Home Infusion Therapy Services for CY 2019 and 2020 (CR10836) The following FAQs address some of the questions received by the DME MACs regarding the temporary transitional payment for home infusion therapy services for CY 2019 and 2020. 01/30/19
Policy Article Revisions Summary for January 31, 2019 Outlined below are the principal changes to the DME MAC Policy Articles (PAs) that have been revised and posted. 01/30/19
Immunosuppressive Drugs Dear Clinician Letter [PDF] Immunosuppressive drugs are covered by Medicare Part B for beneficiaries who have had organ transplants. This Dear Clinician Letter is Revised effective January 2019 01/30/19
Correct Coding - 2019 HCPCS Code Annual Update - Corrected View changes to Level II Healthcare Common Procedure Coding System (HCPCS) codes for 2019. 01/29/19
Contractor Advisory Committee (CAC) Meeting Information - Tumor Treatment Field Therapy (L34823) The DME MACs have received a request from Novocure, the manufacturer of Optune®, to revise the Tumor Treatment Field Therapy (TTFT) LCD to include language indicating that TTFT is reasonable and necessary for newly diagnosed glioblastoma multiforme. 01/24/19
Items Provided on a Recurring Basis and Request for Refill Requirements For all DMEPOS items and supplies provided on a recurring basis, billing must be based on prospective, not retrospective use. 01/10/19
RETIRED - Correct Coding and Coverage of Ventilators - Revised January 2019 Revised to add information about a new device that functions as a ventilator but also incorporates additional functionality of suction, oxygen concentrator, cough stimulation, and nebulizer. 01/10/19
RETIRED - Correct Coding and Coverage - RELiZORB® (Alcresta Therapeutics) In-Line Cartridge Effective for claims with dates of service on or after January 1, 2019, the following code must be used for the RELiZORB® in-line cartridge 01/10/19
RETIRED - Completion of Certificates of Medical Necessity (CMN) Annual Reminder Certificates of medical necessity, commonly known as CMNs, are documents used by the DME MACs to assist in gathering information about the medical necessity of an item. 01/10/19
Last Updated Sep 04 , 2024