Joint DME MAC Publication
Posted April 9, 2026

Outlined below are the principal changes to the DME MAC Local Coverage Determinations (LCDs) and Policy Articles (PAs) that have been revised and posted. The policies included are Ankle-Foot/Knee-Ankle-Foot Orthosis, Intravenous Immune Globulin, Knee Orthoses, Lower Limb Prostheses, Power Mobility Devices, Spinal Orthoses: TLSO and LSO, Urological Supplies, and Wheelchair Options/Accessories. Please review the entire LCDs and PAs for complete information.

Ankle-Foot/Knee-Ankle-Foot Orthosis

LCD

Revision Effective Date: 04/01/2026
HCPCS CODES:
Added: L2221 to Group 1 Codes

04/09/2026: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates per CMS HCPCS coding determinations.

PA

Revision Effective Date: 04/01/2026
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Revised: "Documentation must be sufficiently detailed to include, but is not limited to, a detailed description of the modifications necessary at the time of fitting the orthosis to the beneficiary." to "Documentation must be sufficiently detailed to include, but is not limited to, a detailed description of why the modifications are necessary and what modifications were performed at the time of fitting the orthosis to the beneficiary.," as clarification
CODING GUIDELINES:
Added: Coding guideline information for L2221

04/09/2026: 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.

Intravenous Immune Globulin

LCD

Revision Effective Date: 04/01/2026
HCPCS CODES:
Added: J1553 to Group 1 Codes

04/09/2026: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates due to CMS HCPCS coding determinations.

PA

Revision Effective Date: 04/01/2026
CODING GUIDELINES:
Revised: "milligrams" to "mg" in directions for billing Panzyga, Yimmugo, and GAMMAGARD LIQUID ERC
Revised: "Claims for Yimmugo for dates of service on or after June 13, 2024 must be submitted using the HCPCS code J1599" to "Claims for Yimmugo for dates of service from June 13, 2024 to March 31, 2026 must be submitted using the HCPCS code J1599"
Added: Direction for billing Yimmugo using J1553, effective for dates of service on or after April 1, 2026
Added: Direction for billing Qivigy using J1599, effective for dates of service on or after September 26, 2025 (FDA Approval Date)

04/09/2026: 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.

Knee Orthoses

PA

Revision Effective Date: 01/25/2026
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Revised: "Documentation must be sufficiently detailed to include, but is not limited to, a detailed description of the modifications necessary at the time of fitting the orthosis to the beneficiary." to "Documentation must be sufficiently detailed to include, but is not limited to, a detailed description of why the modifications are necessary and what modifications were performed at the time of fitting the orthosis to the beneficiary.," as clarification
Revised: Custom fabricated language from "For custom fabricated orthoses" to "For a custom fabricated orthosis," as clarification

04/09/2026: 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.

Lower Limb Prostheses

LCD

Revision Effective Date: 04/01/2026
HCPCS CODES:
Added: L5992 to Group 1 Codes

04/09/2026: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates per CMS HCPCS coding determinations.

PA

Revision Effective Date: 04/01/2026
CODING GUIDELINES:
Added: Coding guideline information for L5910, L5920, L5629, L5631, L5649, L5643, L5645, L5651, L5637, and L5650, as clarification
Revised: "For codes L5940, L5950, and L5960, the unit of service is per limb." to "The unit of service for codes L5940, L5950, and L5960 is one per limb." in the coding guideline information for L5940, L5950, and L5960, as clarification
Added: "The unit of service is one per limb." to the coding guideline information for L5783, as clarification
Added: Coding guideline information for L5992

04/09/2026: 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

PA

Revision Effective Date: 10/01/2025
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: Information pertaining to the assistive technology professional assessment, including "The supplier ATP assessment date must be on or after the beginning of the face-to-face process with the treating practitioner and/or LCMP.," as clarification

04/09/2026: 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: 01/23/2024
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Revised: "Documentation must be sufficiently detailed to include, but is not limited to, a detailed description of the modifications necessary at the time of fitting the orthosis to the beneficiary." to "Documentation must be sufficiently detailed to include, but is not limited to, a detailed description of why the modifications are necessary and what modifications were performed at the time of fitting the orthosis to the beneficiary.," as clarification

04/09/2026: 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.

Urological Supplies

LCD

Revision Effective Date: 04/01/2026
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Revised: Information pertaining to the reasonable and necessary quantity of female external urinary collection devices, to include the Tibbe Female External Urinary Device (A4318) quantity
SUMMARY OF EVIDENCE:
Removed: Summary of evidence information, due to not being applicable to the non-discretionary updates
ANALYSIS OF EVIDENCE (RATIONALE FOR DETERMINATION):
Removed: Analysis of evidence information, due to not being applicable to the non-discretionary updates
HCPCS CODES:
Added: A4318 to Group 1 Codes
BIBLIOGRAPHY:
Removed: Bibliography information, due to not being applicable to the non-discretionary updates

04/09/2026: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates per CMS HCPCS coding determinations.

PA

Revision Effective Date: 04/01/2026
CODING GUIDELINES:
Added: "The Tibbe Female External Urinary Device (EUD) (A4318) is a device which is attached to the periurethral area with adhesive and which funnels urine into a closed collection system and can be used with either suction or gravity for drainage."

04/09/2026: 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.

Wheelchair Options/Accessories

PA

Revision Effective Date: 10/01/2025
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: Information pertaining to the assistive technology professional assessment, including "The supplier ATP assessment date must be on or after the beginning of the face-to-face process with the treating practitioner and/or licensed/certified medical professional (LCMP).," as clarification

04/09/2026: 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/or 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.