LCD and Policy Article Revisions Summary for February 19, 2015

Outlined below are the principal changes to a DME MAC Local Coverage Determinations (LCD) and a Policy Article (PA) that have been revised and posted.  Please review the entire LCD and each related PA for complete information.

External Infusion Pumps

LCD

Revision Effective Date: 01/01/2015
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Added: Coverage for Levodopa-Carbidopa enteral suspension (effective for dates of service on or after 01/09/2015)
Added: Coverage for Blinatumomab (effective for dates of service on or after 12/03/2014)
Revised: Standard Documentation Language to add covered prior to a beneficiary's Medicare eligibility
HCPCS CODES AND MODIFIERS:
Added: Codes A4602 and J2274
Deleted:  Codes J2271 and J2275
ICD-9 CODES THAT SUPPORT MEDICAL NECESSITY:
Group 4 Paragraph:
Added: HCPCS Code for Levodopa-Carbidopa enteral suspension
Group 4 Codes:
Added: ICD-9 Code 332.0
Group 5 Paragraph:
Added: HCPCS Code for Blinatumomab
Group 5 Codes:
Added: ICD-9 Code 204.02
DOCUMENTATION REQUIREMENTS:
Revised: Standard Documentation Language to add who can enter date of delivery date on the POD
Added: Instructions for equipment retained from a prior payer 
Added: Repair /Replacement section

Policy Article

Revision Effective Date: 01/01/2015
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Removed: "When required by state law" from ACA new prescription requirements
Revised: Face-to-Face Requirements for treating practitioner
CODING GUIDELINES:
Added: Coding requirements for lithium batteries
Deleted: References to codes J2271 and J2275
Added: Levodopa-Carbidopa enteral suspension (effective for dates of service on or after 01/09/2015) Added: Blinatumomab (effective for dates of service on or after 12/03/2014)

Note: The information contained in this article is only a summary of revisions to the LCD and Policy Article.  For complete information on any topic, you must review the LCD and/or Policy Article.

 

Last Updated Tue, 14 Aug 2018 08:41:39 +0000