Medical Director Articles - 2020

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Title Brief Description Last Updated
Open Meeting Announcement - Glucose Monitors and External Infusion Pumps Local Coverage Determinations This article announces the Open Meeting for the Glucose Monitors and External Infusion Pumps LCDs. 12/17/20
RETIRED - Incorrect Use of HCPCS Codes for Custom Fit Orthotics The DME MACs have recently been made aware of the inappropriate use of HCPCS codes which are considered custom fit orthotics. There are specific HCPCS codes that are considered custom fit orthotics and require more than minimal self-adjustment as published on the PDAC website on the HCPCS to Product and Service Code Crosswalk. 11/12/20
L1005 - Tension Based Scoliosis Orthosis And Accessory Pads, Includes Fitting And Adjustment - Correct Coding The DME MACs and the Pricing, Data Analysis and Coding (PDAC) Contractor are providing this article to educate suppliers to correctly code products which are described by HCPCS code L1005. 11/12/20
RETIRED - L1690 Prefabricated Bilateral Lumbo-sacral Hip Orthosis - Correct Coding The DME MACs and the Pricing, Data Analysis and Coding (PDAC) Contractor are providing this article to educate suppliers to correctly code products which are described by this L-code. 11/12/20
Billing of Powered L-Coded Items - Correct Coding - Revised There are an increasing number of L-coded items which are electrically powered. Errors associated with correct coding these items have been identified in recent reviews. 11/12/20
Primary Care First Model Demonstration Project - Nurse Practitioners as Certifying Physicians for Therapeutic Shoes and Inserts CMS is exercising its authority under the Primary Care First (PCF) model to waive Section 1861(s)(12) of the Act and the implementing regulations at 42 CFR 410.12 to allow nurse practitioners to certify that an order for diabetic shoes is required according to Section 1861(s)(12). 11/05/20
Nurse Practitioners and Physician Assistants as Certifying Physicians for Therapeutic Shoes and Inserts The Centers for Medicare & Medicaid Services (CMS) has recently provided guidance to the DME MACs about the delegation of certifying physician (MD or DO) comprehensive management of diabetes responsibilities to nurse practitioners (NP) and physician assistants (PA) prescribing therapeutic shoes and inserts for persons with diabetes. 11/05/20
Ankle-Foot Orthoses - Arizona-Type - Correct Coding - REVISED This article describes correct coding for the Arizona type ankle-foot orthoses. Arizona AFO is a company that manufactures a line of custom fabricated ankle-foot orthoses. Other companies manufacture similar products. 10/22/20
Correct use of Not Otherwise Specified L-codes for Orthoses and Prostheses - Billing Reminder The Durable Medical Equipment Medicare Administrative Contractors (DME MACs) and Pricing, Data Analysis and Coding (PDAC) Contractor want to remind suppliers on the correct use of a group of L-codes which share the phrase, "Not otherwise specified" (NOS). 10/22/20
Enteral Nutrition - Correct Coding and Billing In order for a beneficiary's nutrition to be eligible for reimbursement the reasonable and necessary (R&N) requirements set out in the National Coverage Determinations (NCD) Manual (CMS Pub. 100-03), Chapter 1, Section 180.2 must be met. 10/08/20
Parenteral Nutrition - Correct Coding and Billing In order for a beneficiary's nutrition to be eligible for reimbursement, the reasonable and necessary (R&N) requirements set out in the National Coverage Determinations (NCD) Manual (CMS Pub. 100-03), Chapter 1, Section 180.2, must be met. 10/08/20
Retirement of Enteral Nutrition Local Coverage Determination (LCD) and Related Policy Article - Effective November 12, 2020 The DME MACs will be retiring the Enteral Nutrition LCD (L33783) and related Policy Article (A52493), effective for claims with dates of service on or after November 12, 2020, due to the evolution of enteral nutrition clinical paradigms. 10/08/20
Retirement of Parenteral Nutrition Local Coverage Determination (LCD) and Related Policy Article - Effective November 12, 2020 The DME MACs will be retiring the Parenteral Nutrition LCD (L33798) and related Policy Article (A52515), effective for claims with dates of service on or after November 12, 2020, due to the evolution of parenteral nutrition clinical paradigms. 10/08/20
RETIRED - MyoPro® (Myomo, Inc.) Assist Device - Correct Coding - Revised Effective for dates of service on or after October 1, 2020, the code descriptors for the MyoPro® upper extremity assist device have changed. 09/24/20
L1686 Prefabricated Hip Abduction Orthosis - Correct Coding L1686 describes a prefabricated orthosis with a semirigid or rigid waist band connected to a single rigid upright, hip joint and rigid thigh cuff. 09/17/20
Same or Similar Denials for Orthoses and the Appeals Process Items that are identical or similar to items previously paid for by Medicare may be provided when the item is lost, stolen, irreparably damaged, or there has been a change in the beneficiary’s  medical/physiological condition. 08/27/20
External Infusion Pumps Final LCD (L33794) and Response to Comments (RTC) Article Published The DME MACs published the External Infusion Pumps Final LCD (L33794) and LCD-related Policy Article (PA) (A52507) 07/23/20
Scoliosis Brace - Correct Coding The DME MACs wants to reminder DMEPOS suppliers about the correct coding for scoliosis braces. 07/22/20
Insulin Infusion Pumps with Integrated Continuous Glucose Sensing Capabilities and Related Accessories/Supplies - Codes E0787 and A4226 - Correct Coding HCPCS Code E0787 and A4226 will become invalid on or after September 15, 2020. 07/20/20
Correct Coding and Coverage of Ventilators - Revised July 2020 View information about the application of Medicare proper coding and payment rules for ventilators. 07/16/20
CMS Issues Interim Final Rules with Comment (CMS-1744-IFC & CMS-5531-IFC) - COVID-19 Public Health Emergency - Revised On April 6, 2020, the Centers for Medicare & Medicaid Services (CMS) issued an interim final rule with comment (CMS-1744-IFC), establishing that certain requirements for face-to-face/in-person encounters will not apply during the COVID-19 public health emergency. 06/29/20
Prosthetic Feet and Additions to Lower Limb Extremity Prostheses - Correct Coding and Coding Verification Review Requirement CMS published the continuation of prior authorization for 45 HCPCS codes on the Required Prior Authorization List of DMEPOS Items that require prior authorization as a condition of payment including three prosthetic foot system codes. 06/25/20
RETIRED - Xembify® - Correct Coding Xembify® is included in the External Infusion Pumps Local Coverage Determination (LCD L33794). 06/18/20
Oxygen and Oxygen Equipment Final LCD (L33797) and Response to Comments (RTC) Article Published Today the DME MACs published the Oxygen and Oxygen Equipment Final LCD (L33797) and Response to Comments (RTC) Article 06/18/20
RETIRED - Incorrect Use of HCPCS Code A9279 - Correct Coding The DME MACs have recently been made aware of the inappropriate use of HCPCS code A9279 (MONITORING FEATURE/DEVICE, STAND-ALONE OR INTEGRATED, ANY TYPE, INCLUDES ALL ACCESSORIES, COMPONENTS AND ELECTRONICS, NOT OTHERWISE CLASSIFIED). 06/11/20
Urological Supplies Final LCD (L33803) and Response to Comments (RTC) Article Published The DME MACs published the Urological Supplies Final LCD (L33803), LCD-related Policy Article (PA) (A52521) and Response to Comments Article. 06/11/20
RETIRED - Use of CR modifier and “COVID-19” narrative on Specified Claims Due to the COVID-19 PHE This bulletin article reminds suppliers to append the CR modifier and “COVID-19” narrative to claims for dates of service on or after March 1, 2020, where the coverage, coding or documentation requirements are impacted by the COVID-19 Public Health Emergency (PHE). 05/28/20
CMS Issues Interim Final Rules with Comment (CMS-1744-IFC & CMS-5531-IFC) - COVID-19 Public Health Emergency - Revised On April 6, 2020, the Centers for Medicare & Medicaid Services (CMS) issued an interim final rule with comment (CMS-1744-IFC), establishing that certain requirements for face-to-face/in-person encounters will not apply during the COVID-19 public health emergency. 05/21/20
Correct Use of the KX Modifier During the COVID-19 PHE On or after March 1, 2020 and for the duration of the COVID-19 Public Health Emergency (PHE), for the following LCDs in which the Face-to-Face evaluation or other services with an implied Face-to-Face evaluation such as a home assessment are waived during the PHE. 05/14/20
Billing of Part B Drugs and Enteral Nutrition to DME MACs During COVID-19 Pandemic - Dispensing Amounts - Revised The Centers for Medicare & Medicaid Services (CMS), under their National Emergency authority, is allowing Medicare beneficiaries to obtain amounts of Part B drugs in excess of the current monthly (30 day) limitation during COVID-19 Pandemic. 05/11/20
RETIRED - CMS Issues Interim Final Rules with Comment (CMS-1744- IFC & CMS-5531-IFC) - COVID-19 Public Health Emergency On April 6, 2020, the Centers for Medicare & Medicaid Services (CMS) issued an interim final rule with comment (CMS-1744-IFC), establishing that certain requirements for face-to-face/in-person encounters will not apply during the COVID-19 public health emergency. 05/07/20
Open Meeting Announcement - External Infusion Pumps (DL33794) This article announces the Open Meeting for the External Infusion Pumps LCD 04/30/20
External Infusion Pumps Open Meeting Agenda This article announces the Agenda for the External Infusion Pumps LCD 04/30/20
Required Prior Authorization Suspended for the Duration of the COVID-19 Pandemic Effective on or after March 01, 2020, the Centers for Medicare & Medicaid Services (CMS) and the DME MACs are suspending the requirements to prior authorize certain power mobility devices (PMDs) and pressure reducing support surfaces (PRSS). 04/03/20
External Infusion Pumps Final LCD (L33794) and Response to Comments (RTC) Article Published The DME MACs published the External Infusion Pumps Final LCD (L33794) and LCD-related Policy Article (PA) (A52507) 04/16/20
Nebulizers Final LCD (L33370) and Response to Comments (RTC) Article Published The DME MACs published the Nebulizers Final LCD (L33370) and LCD-related Policy Article (PA) (A52466) 04/02/20
RETIRED - Billing of Part B Drugs to DME MACs During COVID-19 Pandemic - Dispensing Amounts The Centers for Medicare & Medicaid Services (CMS), under their National Emergency authority, is allowing Medicare beneficiaries to obtain amounts of Part B drugs in excess of the current monthly (30 day) limitation during COVID-19 Pandemic. 03/19/20
L3960 - Coding Verification Review Requirement This article reminds DMEPOS suppliers the description of HCPCS code L3960 and establishes a written coding verification review for dates of service on or after August 1, 2020 by the PDAC. 03/12/20
Frequently Asked Questions - Final Rule CMS-1713-F - Standard Written Orders The following FAQs address some of the questions received by the DME MACs regarding Final Rule CMS-1713-F and the Standard Written Order requirements 03/12/20
2020 HCPCS Code Annual Update - Correct Coding - Revised This article identifies changes to Level II Healthcare Common Procedure Coding System (HCPCS) codes for 2020 02/20/20
Completion of Certificates of Medical Necessity (CMN) - Annual Reminder [PDF] Annual reminder regarding the completion of the Certificate of Medical Necessity, commonly known as CMNs, which are documents used by the DME MACs to assist in gathering information about the medical necessity of an item. 01/23/20
Items Provided on a Recurring Basis and Request for Refill Requirements Annual reminder for all DMEPOS items and supplies provided on a recurring basis, billing must be based on prospective, not retrospective use. 01/22/20
Open Meeting Announcement - Urological Supplies (DL33803) This article announces the Open Meeting for Urological Supplies (DL33803) 01/16/20
Oxygen and Oxygen Equipment, Nebulizers, External Infusion Pumps and Urological Supplies Open Meeting Agenda This article provides the agenda for the upcoming Open Meeting on January 28, 2020 01/16/20

Last Updated Mon, 25 Oct 2021 21:03:15 +0000