LCD and Policy Article Revisions Summary for May 4, 2017

Posted on May 4, 2017

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 Automatic External Defibrillators, Intrapulmonary Percussive Ventilation System, Manual Wheelchair Bases, Oral Appliances for Obstructive Sleep Apnea, Ostomy Supplies, Pneumatic Compression Devices, Refractive Lenses,  Speech Generating Devices, and Therapeutic Shoes for Persons with Diabetes. The Policy Article for Immunosuppressive Drugs was also updated. Please review the entire LCD and related PA for complete information.

Automatic External Defibrillators
LCD
Revision Effective Date: 01/01/2017
COVERAGE INDICATIONS, INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

Removed: Standard Documentation Language

Added: New reference language and directions to Standard Documentation Requirements

Added: General Requirements

DOCUMENTATION REQUIREMENTS:

Removed: Standard Documentation Language

Added: General Documentation Requirements

Added: New reference language and directions to Standard Documentation Requirements

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

Removed: Standard Documentation Language

Added: Direction to Standard Documentation Requirements

Removed: Supplier Manual reference from Miscellaneous

Removed: PIM reference from Appendices

RELATED LOCAL COVERAGE DOCUMENTS:

Added: LCD-related Standard Documentation Requirements article

Policy Article
Revision Effective Date: 01/01/2017

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

Added: 42 CFR 410.38(g)

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

Added: Modifier instructions

RELATED LOCAL COVERAGE DOCUMENTS:

Added: LCD-related Standard Documentation Requirements Language Article

 

Intrapulmonary Percussive Ventilation System
LCD
Revision Effective Date: 01/01/2017

COVERAGE INDICATIONS, INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

Removed: Standard Documentation Language

Added: New reference language and directions to Standard Documentation Requirements

Added: General Requirements

DOCUMENTATION REQUIREMENTS:

Added: General Documentation Requirements

Added: New reference language and directions to Standard Documentation Requirements

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

Added: Direction to Standard Documentation Requirements

Removed: Supplier Manual Reference from Miscellaneous

Removed: PIM reference from Appendices

RELATED LOCAL COVERAGE DOCUMENTS:

Added: LCD-related Standard Documentation Requirements article

Policy Article
Revision Effective Date: 01/01/2017

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

Added: Direction to Standard Documentation Requirements

RELATED LOCAL COVERAGE DOCUMENTS:

Added: LCD-related Standard Documentation Requirements Language Article

 

Manual Wheelchair Bases
LCD
Revision Effective Date: 01/01/2017
COVERAGE INDICATIONS, INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

Removed: Standard Documentation Language

Added: New reference language and directions to Standard Documentation Requirements

Added: General Requirements

DOCUMENTATION REQUIREMENTS:

Removed: Standard Documentation Language

Added: General Documentation Requirements

Added: New reference language and directions to Standard Documentation Requirements

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

Removed: Standard Documentation Language

Added: Direction to Standard Documentation Requirements

Removed: Reference to Supplier Manual under Miscellaneous

Removed: Reference to PIM under Appendices

RELATED LOCAL COVERAGE DOCUMENTS:

Added: LCD-related Standard Documentation Requirements article

Policy Article
Revision Effective Date: 01/01/2017
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES

Added: 42 CFR 410.38(g)

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

Added: Home assessment requirements, ADMC eligible bases, medical necessity documentation requirements for K0005, K0008, E1037, E1038, E1039, and Modifier instructions

RELATED LOCAL COVERAGE DOCUMENTS:

Added: LCD-related Standard Documentation Requirements Language Article

 

Oral Appliances for Obstructive Sleep Apnea
LCD
Revision Effective Date: 01/01/2017

COVERAGE INDICATIONS, INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

Removed: Standard Documentation Language

Added: New reference language and directions to Standard Documentation Requirements

Added: General Requirements

DOCUMENTATION REQUIREMENTS:

Removed: Standard Documentation Language

Added: General Documentation Requirements

Added: New reference language and directions to Standard Documentation Requirements

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

Removed: Standard Documentation Language

Added: Direction to Standard Documentation Requirements

Removed: Supplier manual reference from Miscellaneous

Removed: PIM reference under Appendices

RELATED LOCAL COVERAGE DOCUMENTS:

Added: LCD-related Standard Documentation Requirements article

Policy Article
Revision Effective Date: 01/01/2017

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

Added: Face to Face clinical evaluation, Modifier requirements

CODING GUIDELINES:

Revised: Examples of articulations that do not meet the requirement of a fixed hinge.

RELATED LOCAL COVERAGE DOCUMENTS:

Added: LCD-related Standard Documentation Requirements Language Article

 

Ostomy Supplies
LCD
Revision Effective Date: 01/01/2017

COVERAGE INDICATIONS, INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

Removed: Standard Documentation Language

Added: New reference language and directions to Standard Documentation Requirements

Added: General Requirements

Revised: Refill Requirements

DOCUMENTATION REQUIREMENTS:

Removed: Standard Documentation Language

Added: General Documentation Requirements

Added: New reference language and directions to Standard Documentation Requirements

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

Removed: Standard Documentation Language

Added: Direction to Standard Documentation Requirements

Removed: Supplier Manual reference from Miscellaneous

Removed: PIM reference from Appendices

RELATED LOCAL COVERAGE DOCUMENTS:

Added: LCD-related Standard Documentation Requirements article

Policy Article
Revision Effective Date: 01/01/2017

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

Added: Billing Directions

RELATED LOCAL COVERAGE DOCUMENTS:

Added: Standard Documentation Language article

 

Pneumatic Compression Devices
LCD
Revision Effective Date: 01/01/2017

COVERAGE INDICATIONS, INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

Removed: Standard Documentation Language

Added: New reference language and directions to Standard Documentation Requirements

Added: General Requirements

DOCUMENTATION REQUIREMENTS:

Removed: Standard Documentation Language

Added: General Documentation Requirements

Added: New reference language and directions to Standard Documentation Requirements

POLICY SPECIFIC DOCUMENTATION

REQUIREMENTS:

Removed: Standard Documentation Language

Added: Direction to Standard Documentation Requirements

Removed: Supplier manual reference under Miscellaneous

Removed: PIM reference under Appendices

SOURCES OF INFORMATION AND BASIS FOR DECISION:

Removed: Links

RELATED LOCAL COVERAGE DOCUMENTS:

Added: LCD-related Standard Documentation Requirements article

Policy Article
Revision Effective Date: 01/01/2017

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

Added: 42 CFR 410.38(g)

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

Added: General and CMN requirements

RELATED LOCAL COVERAGE DOCUMENTS:

Added: LCD-related Standard Documentation Requirements Language Article

 

Refractive Lenses
LCD
Revision Effective Date: 01/01/2017

COVERAGE INDICATIONS, INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

Removed: Standard Documentation Language

Added: New reference language and directions to Standard Documentation Requirements

Added: General Requirements

DOCUMENTATION REQUIREMENTS:

Removed: Standard Documentation Language

Added: General Documentation Requirements

Added: New reference language and directions to Standard Documentation Requirements

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

Removed: Standard Documentation Language

Added: Direction to Standard Documentation Requirements

Removed: PIM reference from Appendices

RELATED LOCAL COVERAGE DOCUMENTS:

Added: LCD-related Standard Documentation Requirements article

Policy Article
Revision Effective Date: 01/01/2017

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

Added: Diagnosis requirement on a claim and Modifier instructions

RELATED LOCAL COVERAGE DOCUMENTS:

Added: LCD-related Standard Documentation Requirements Language Article

 

Speech Generating Devices
LCD
Revision Effective Date: 01/01/2017

COVERAGE INDICATIONS, INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

Removed: Standard Documentation Language

Added: New reference language and directions to Standard Documentation Requirements

Added: General Requirements

DOCUMENTATION REQUIREMENTS:

Removed: Standard Documentation Language

Added: General Documentation Requirements

Added: New reference language and directions to Standard Documentation Requirements

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

Removed: Standard Documentation Language

Added: Direction to Standard Documentation Requirements

Removed: Supplier Manual reference from Miscellaneous

Removed: PIM reference from Appendices

RELATED LOCAL COVERAGE DOCUMENTS:

Added: LCD-related Standard Documentation Requirements article

Policy Article
Revision Effective Date: 01/01/2017

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

Removed: Standard Documentation Language

Added: 42 CFR 410.38(g)

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

Added: Documentation and billing instructions for E2511-E2599 (previously in the LCD) and Modifier instructions

RELATED LOCAL COVERAGE DOCUMENTS:

Added: LCD-related Standard Documentation Requirements Language Article

 

Therapeutic Shoes for Persons with Diabetes
LCD
Revision Effective Date: 01/01/2017

COVERAGE INDICATIONS, INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

Removed: Standard Documentation Language

Added: New reference language and directions to Standard Documentation Requirements

Added: General Requirements

DOCUMENTATION REQUIREMENTS:

Removed: Standard Documentation Language

Added: General Documentation Requirements

Added: New reference language and directions to Standard Documentation Requirements

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

Removed: Standard Documentation Language

Added: Direction to Standard Documentation Requirements

Removed: Supplier Manual reference from Miscellaneous

Removed: PIM reference from Appendices

RELATED LOCAL COVERAGE DOCUMENTS:

Added: LCD-related Standard Documentation Requirements article

Policy Article
Revision Effective Date: 01/01/2017

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

Modifier instructions, Certification requirements and in-person evaluation requirements

RELATED LOCAL COVERAGE DOCUMENTS:

Added: LCD-related Standard Documentation Requirements Language Article

 

Immunosuppressive Drugs
Policy Article
Revision Effective Date: 01/01/2017

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

Added: Continued Medical Need and Continued Use sections (clerical error)

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

Last Updated Wed, 03 May 2017 09:14:18 +0000