LCD and Policy Article Revisions Summary for April 4, 2019 - JD DME
LCD and Policy Article Revisions Summary for April 4, 2019
Outlined below are the principal changes to the DME MAC Local Coverage Determinations (LCDs) and Policy Articles that have been revised and posted. The policies included are: Mechanical In-exsufflation Devices, Nebulizers, Oral Appliances for Obstructive Sleep Apnea, Oxygen and Oxygen Equipment, Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea, Power Mobility Devices, Respiratory Assist Devices, Standard Documentation Requirements for All Claims Submitted to DME MACs, Suction Pumps and Therapeutic Shoes for Persons with Diabetes. Please review the entire LCDs and related PAs for complete information.
Mechanical In-exsufflation Devices
PA
Revision Effective Date: 01/01/2019
CODING GUIDELINES:
- Revised: E0467 Coding Guidelines to include custom fabricated oral appliances
04/04/2019: 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.
Nebulizers
PA
Revision Effective Date: 01/01/2019
CODING GUIDELINES:
- Revised: E0467 Coding Guidelines to include custom fabricated oral appliances
04/04/2019: 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.
Oral Appliances for Obstructive Sleep Apnea
LCD
Revision Effective Date: 01/01/2019
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
- Removed: Statement to refer to diagnosis code section below
- Added: Refer to Covered ICD-10 Codes in the LCD-related Policy Article
ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:
- Moved: Diagnosis code to the LCD-related Policy Article diagnosis code section per CMS instruction
ICD-10 CODES THAT DO NOT SUPPORT MEDICAL NECESSITY:
- Moved: Statement about noncovered diagnosis codes moved to LCD-related Policy Article noncovered diagnosis code section per CMS instruction
PA
Revision Effective Date: 01/01/2019
CODING GUIDELINES:
- Added: E0467 Coding Guidelines
- Revised: Language for custom fabricated oral appliance (E0486)
ICD-10 CODES THAT ARE COVERED:
- Added: Diagnosis code formerly listed in the LCD
ICD-10 CODES THAT ARE NOT COVERED:
- Added: Notation excluding all unlisted diagnosis codes from coverage
04/04/2019: 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.
Oxygen and Oxygen Equipment
PA
Revision Effective Date: 01/01/2019
CODING GUIDELINES:
- Revised: E0467 Coding Guidelines to include custom fabricated oral appliances
- Added: E0447, E1405, and E1406 to HCPCS codes included in E0467
04/04/2019: 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.
Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea
PA
Revision Effective Date: 01/01/2019
CODING GUIDELINES:
- Revised: E0467 Coding Guidelines to include custom fabricated oral appliances
04/04/2019: 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.
Power Mobility Devices
LCD
Revision Effective Date: 01/01/2019
PRESCRIPTION (ORDER) REQUIREMENTS:
- Revised: PIM reference for 7-Element Orders from 5.9.2 to 5.2.4
- Updated: 7-Element Order elements to be consistent with the PIM
PA
Revision Effective Date: 01/01/2019
POLICY SPECFIC DOCUMENTATION:
- Removed: Prior Authorization of Power Mobility Devices (PMD) Demonstration information as program ended August 31, 2018.
CODING GUIDELINES:
- Added: Coding guidelines for power wheelchair electronics
04/04/2019: 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.
Respiratory Assist Devices
PA
Revision Effective Date: 01/01/2019
CODING GUIDELINES:
- Revised: E0467 Coding Guidelines to include custom fabricated oral appliances
04/04/2019: 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.
Standard Documentation Requirements for All Claims Submitted to DME MACs
PA
Revision Effective Date: 01/01/2019
ARTICLE TEXT:
- Removed: Last updated date
POWER MOBILITY DEVICES WOPD (7 ELEMENT ORDER):
- Revised: 42 CFR 410.38(c) paragraph to remove the reference to HCPCS table
PROOF OF DELIVERY (POD):
- Added: Postage paid delivery invoice option for POD documentation
04/04/2019: 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.
Suction Pumps
PA
Revision Effective Date: 01/01/2019
CODING GUIDELINES:
- Revised: E0467 Coding Guidelines to include custom fabricated oral appliances
04/04/2019: 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
LCD
Revision Effective Date: 01/01/2019
HCPCS CODES:
- Removed: K0903 from Group 1 Codes, per annual HCPCS code release
- Added: A5514 to Group 1 codes, crosswalk from K0903, per annual HCPCS code release
- Revised: A5513 code narrative, per annual HCPCS code release
PA
Revision Effective Date: 01/01/2019
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
- Revised: References to K0903 crosswalked to A5514
CODING GUIDELINES:
- Revised: References to K0903 crosswalked to A5514
- Revised: RT and LT modifier billing instructions (Effective 03/01/2019)
04/04/2019: 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 PAs. For complete information on any topic, you must review the LCDs and/or PAs.