LCD and Policy Article Revisions Summary for February 14, 2019 - JD DME

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: Cold Therapy, Enteral Nutrition, External Breast Prostheses, External Infusion Pumps, High Frequency Chest Wall Oscillation Devices, Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics), Oxygen and Oxygen Equipment, Spinal Orthoses: TLSO and LSO, and Wheelchair Options and Accessories. Please review the entire LCDs and related PAs for complete information.

Cold Therapy

LCD

Revision Effective Date: 01/01/2019
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Revised: Code descriptor for E0218 from water to fluid
HCPCS CODES:
Revised: Code descriptor for A9273 from water to fluid and expanded to include cold or hot fluid
Revised: Code descriptor for E0218 from water to fluid

PA

Revision Effective Date: 01/01/2019
CODING GUIDELINES:
Revised: Coding guidelines for A9270
Added: Coding guideline for A9273
Revised: Code descriptor for E0218 from water to fluid per annual HCPCS code update

02/14/2019: 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.

Enteral Nutrition

LCD

Revision Effective Date: 01/01/2019
HCPCS CODES:
Added: HCPCS B4105

PA

Revision Effective Date: 01/01/2019
CODING GUIDELINES:
Revised: 'these supplies' to 'these supply allowances' for enteral feeding supplies
Added: In-Line Cartridge Coding Guidelines and billing instructions for Q9994 and B4105

02/14/2019: 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.

External Breast Prostheses

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: All diagnosis codes 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 code moved to LCD-related Policy Article noncovered diagnosis section per CMS instruction.

PA

Revision Effective Date: 01/01/2019
CODING GUIDELINES:
Added: Lycra to L8000 code description
Revised: RT and/or LT modifier instructions
ICD-10 CODES THAT ARE COVERED:
Added: All diagnosis codes formerly listed in the LCD
ICD-10 CODES THAT ARE NOT COVERED:
Added: Notation excluding all unlisted diagnosis codes from coverage

02/14/2019: 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.

External Infusion Pumps

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
Revised: Effective for claims with dates of service on or after 03/29/2018 allow additional cycles of Blinatumomab (J9039)
HCPCS CODES:
Added: HCPCS codes G0068, G0069, and G0070 to Group 3 codes
ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:
Moved: All diagnosis codes 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 code moved to LCD-related Policy Article noncovered diagnosis section per CMS instruction

PA

Revision Effective Date: 01/01/2019
CODING GUIDELINES:
Added: Professional services description
ICD-10 CODES THAT ARE COVERED:
Added: All diagnosis codes formerly listed in the LCD
ICD-10 CODES THAT ARE NOT COVERED:
Added: Notation excluding all unlisted diagnosis codes from coverage

02/14/2019: 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.

High Frequency Chest Wall Oscillation Devices

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
HCPCS CODES:
Revised: Code descriptor for E0483
ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:
Moved: All diagnosis codes 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:
Revised: Code descriptor for E0483
ICD-10 CODES THAT ARE COVERED:
Added: All diagnosis codes formerly listed in the LCD
ICD-10 CODES THAT ARE COVERED:
Added: Notation excluding all unlisted diagnosis codes from coverage

02/14/2019: 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 Antiemetic Drugs (Replacement for Intravenous Antiemetics)

LCD

Revision Effective Date: 01/01/2019
HCPCS CODES:
Added: "ORAL" to HCPCS code J8655

PA

Revision Effective Date: 01/01/2019
CODING GUIDELINES:
Added: "ORAL" to HCPCS code J8655 code description

02/14/2019: 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

LCD

Revision Effective Date: 01/01/2019
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Removed: NCD language
Removed: Statement to refer to diagnosis code section below
Added: Refer to Covered ICD-10 Codes in the LCD-related Policy Article
HCPCS CODES:
Added: HCPCS E0447
ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:
Moved: All diagnosis codes 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 code moved to LCD-related Policy Article noncovered diagnosis code section per CMS instruction

PA

Revision Effective Date: 01/01/2019
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: E0447 to Oxygen Content guidelines
CODING GUIDELINES:
Added: E0467 Coding Guidelines
Revised: E1405 and E1406 Coding Guidelines
ICD-10 CODES THAT ARE COVERED:
Added: All diagnosis codes formerly listed in the LCD
ICD-10 CODES THAT ARE NOT COVERED:
Added: Notation excluding all unlisted diagnosis codes from coverage

02/14/2019: 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.

Spinal Orthoses: TLSO and LSO

PA

Revision Effective Date: 01/01/2019
CODING GUIDELINES:
Revised: Coding instructions for prefabricated orthoses without distinction of OTS or custom-fit.

02/14/2019: 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.

Wheelchair Options and Accessories

LCD

Revision Effective Date: 01/01/2019
HCPCS CODES:
Revised: K0037 narrative to remove "replacement only"

PA

Revision Effective Date: 01/01/2019
CODING GUIDELINES:
Removed: K0037 from "replacement only" items
Revised: RT and LT modifier billing instructions (Effective 03/01/2019)

02/14/2019: 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.