Joint DME MAC Publication
Posted October 1, 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, Automatic External Defibrillators, External Breast Prostheses, Immunosuppressive Drugs, Manual Wheelchair Bases, Oral Anticancer Drugs, Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics), and Walkers. Please review the entire LCD and PAs for complete information.

Ankle-Foot/Knee-Ankle-Foot Orthosis

LCD

Revision Effective Date: 10/01/2026
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Added: L1972 to the HCPCS codes that describe ankle-foot orthoses (AFOs) that are covered for ambulatory beneficiaries with weakness or deformity of the foot and ankle who meet specified criteria
HCPCS CODES:
Revised: Long description of L1971, in Group 1 Codes
Added: L1972 to Group 1 Codes

10/01/2026: 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: 10/01/2026
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: L1972 to the prefabricated orthoses HCPCS codes
CODING GUIDELINES:
Added: A row to the table that pertains to corresponding sets of HCPCS codes; the added row contains L1971 in Column I and L1972 in Column II
Added: L1972 to the HCPCS codes for ankle-foot orthoses that extend well above the ankle (usually to near the top of the calf) and are fastened around the lower leg above the ankle
Revised: Long description of L1971
Added: Coding guideline information for L1972
ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY:
Removed: M72.2 from Group 1 Codes, due to ICD-10-CM code updates
Added: M67.A01 and M67.A02 to Group 1 Codes, due to ICD-10-CM code updates

10/01/2026: 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.

Automatic External Defibrillators

PA

Revision Effective Date: 10/01/2026
ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY:
Removed: I42.0 and I42.8 from Group 2 Codes, due to ICD-10-CM code updates
Added: I42.00, I42.01, I42.09, I42.81, I42.89, I49.81, I49.82, and I49.89 to Group 2 Codes, due to ICD-10-CM code updates

10/01/2026: 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.

External Breast Prostheses

LCD

Revision Effective Date: 10/01/2026
HCPCS CODES:
Revised: Long description of L8030, L8031, and L8035

10/01/2026: 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.

Immunosuppressive Drugs

LCD

Revision Effective Date: 10/01/2026
HCPCS CODES:
Added: J7524, J7529, J7530, and J7531 to Group 1 Codes
Removed: J7514, J7517, and J7528 from Group 1 Codes

10/01/2026: 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.

Manual Wheelchair Bases

LCD

Revision Effective Date: 10/01/2026
CMS NATIONAL COVERAGE POLICY:
Added: "280.1," as clarification
HCPCS CODES:
Added: E0150 to Group 1 Codes

10/01/2026: 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: 10/01/2026
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: E0150 benefit category coverage information for dates of service on or after October 1, 2025 through September 30, 2026 and for dates of service on or after October 1, 2026
MODIFIERS:
Added: KX modifier information for E0150 for claims with dates of service on or after October 1, 2026 when coverage criteria in the Walkers LCD (L33791) and in the Manual Wheelchair Bases LCD (L33788) have been met
Revised: GY modifier information, to include that the GY modifier must be appended to E0150 if E0150 is only to be used for mobility outside the home
CODING GUIDELINES:
Revised: "Manual Wheelchair Bases" to "Other Manual Wheelchairs," as clarification
Added: "Combination wheeled walker with seat and transport chair (E0150)" to the list of manual wheelchair bases that describe a complete product
Revised: "Adult manual wheelchairs (K0001, K0002, K0003, K0004, K0005, K0006, K0007, K0008, K0009, E1161) are" to "Adult manual wheelchairs described by HCPCS codes K0001, K0002, K0003, K0004, K0005, K0006, K0007, K0008, K0009, E1161 are," as clarification
Revised: "Manual wheelchair bases (K0001, K0002, K0003, K0004, K0005, K0006, K0007, K0008, and K0009) include" to "Manual wheelchair bases coded K0001, K0002, K0003, K0004, K0005, K0006, K0007, K0008, and K0009 include," as clarification
Added: Coding guideline information for E0150

10/01/2026: 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.

Oral Anticancer Drugs

PA

Revision Effective Date: 10/01/2026
ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY:
Added: ICD-10-CM code C79.83 to Group 6 Codes, due to ICD-10-CM code updates

10/01/2026: 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.

Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics)

PA

Revision Effective Date: 10/01/2026
ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY:
Added: ICD-10-CM codes C78.31, C78.32, and C79.83 to Group 1 Codes, due to ICD-10-CM code updates

10/01/2026: 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.

Walkers

LCD

Revision Effective Date: 10/01/2026
CMS NATIONAL COVERAGE POLICY:
Added: "280.1," as clarification
HCPCS CODES:
Added: E0150 to Group 1 Codes

10/01/2026: 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: 10/01/2026
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Revised: E0150 benefit category information (which noted that E0150 was noncovered), to include dates of service on or after October 1, 2025 through September 30, 2026
Added: E0150 benefit category information for dates of service on or after October 1, 2026
MODIFIERS:
Revised: KX modifier information for heavy duty walker claims, by revising "the beneficiary's weight (within one month of providing the walker) is greater than 300 pounds" to "only if all of the standard walker coverage criteria (1-3) have been met and the beneficiary's weight (within one month of providing the walker) is greater than 300 pounds," as clarification
Added: KX modifier information for E0150 for claims with dates of service on or after October 1, 2026 when coverage criteria in the Walkers LCD (L33791) and in the Manual Wheelchair Bases LCD (L33788) have been met
Revised: GY modifier information, to include that the GY modifier must be appended to E0150 if E0150 is only to be used for mobility outside the home
Revised: "Claims lines billed with codes E0148 and E0149 without a KX, GA, GY or GZ modifier will be rejected as missing information." to "Claim lines billed with codes E0148, E0149, and E0150 without a KX, GA, GY, or GZ modifier will be rejected as missing information."
CODING GUIDELINES:
Added: Coding guideline information for E0150
Revised: Information describing the table that contains Column I and Column II codes, by revising "A Column II code is included in the allowance for the corresponding Column I code when provided at the same time and must not be billed separately at the time of billing the Column I code." to "A Column II code must not be billed at the time of billing the Column I code.," as clarification
Revised: The table that contains Column I and Column II codes, by adding a row that contains E0150 in Column I and that contains A4636, A4637, E0130, E0135, E0140, E0141, E0143, E0144, E0155, E0156, E0159, E1031, E1037, E1038, and E1039 in Column II

10/01/2026: 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.