LCD and Policy Article Revisions Summary for February 5, 2026 - JD DME

Joint DME MAC Publication
Posted February 5, 2026

Outlined below are the principal changes to the DME MAC Local Coverage Determination (LCD) and Policy Articles (PAs) that have been revised and posted. The policies included are External Infusion Pumps and Intravenous Immune Globulin. Please review the entire LCDs and PAs for complete information.

External Infusion Pumps

LCD

Revision Effective Date: 01/25/2026
CMS NATIONAL COVERAGE POLICY:
Added: 280.1
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Revised: "Gallium nitrate (J1457)" to "Gallium nitrate (J7799)" in criterion F due to the discontinuation of J1457 (effective 01/01/2026)
Removed: Specific group number references to ICD-10 Code Groups in the LCD-related Policy Article
Clarification: Coverage for blinatumomab for consolidation phase of multiphase chemotherapy for acute lymphoblastic leukemia (ALL) effective for dates of service on or after 06/14/2024 (FDA Approval Date)
HCPCS CODES:
Removed: J1562 from Group 3 Codes (effective 01/01/2026)
Removed: J0288 and J1457 from Group 4 Codes (effective 01/01/2026)

02/05/2026: 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: 01/25/2026
MODIFIERS:
Removed: J1562 from JB modifier section
CODING GUIDELINES:
Removed: Past timely filing directions regarding billing for E0784, E1399 (for an adjunctive continuous glucose monitor or receiver), A4224, A4225, and A9999 (for supplies and accessories used in conjunction with an insulin pump, which also performs the functions of an adjunctive continuous glucose monitor or receiver)
Removed: Past timely filing directions regarding billing for levodopa-carbidopa
Clarification: Alternative infusion protocol information pertaining to beneficiaries using a 3-day infusion protocol and pertaining to beneficiaries using a 4-day infusion protocol is effective for dates of service on or after 12/17/2024 (FDA Approval Date)
Removed: Past timely filing directions regarding billing for the following: blinatumomab, HYQVIA, CUVITRU, Xembify, and Cutaquig
Added: Billing direction for gallium nitrate
Removed: J1562 from SCIg preparations column in the table
PROFESSIONAL SERVICES:
Removed: Past timely filing directions for G0068, G0069, and G0070
ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY:
Revised: "For HCPCS code J1457" to "For gallium nitrate" in Group 2 Paragraph
Removed: J1562 from Group 3 Paragraph

02/05/2026: 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.

Intravenous Immune Globulin

PA

Revision Effective Date: 06/27/2025
CODING GUIDELINES:
Added: Direction for billing Yimmugo using J1599, effective for dates of service on or after June 13, 2024 (FDA Approval Date)
Added: Direction for billing GAMMAGARD LIQUID ERC using J1569, effective for dates of service on or after June 27, 2025 (FDA Approval Date)

02/05/2026: 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.

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.