LCD and Policy Article Revisions Summary for May 7 2015 - JD DME

LCD and Policy Article Revisions Summary for May 7, 2015

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

Automatic External Defibrillators
LCD
Revision Effective Date: 10/31/2014
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Revised: Standard Documentation Language to add covered prior to a beneficiary's Medicare eligibility
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
Revised: Repair to beneficiary-owned DMEPOS

Policy Article
Revision Effective Date: 10/31/2014
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

Enteral Nutrition
LCD
Revision Effective Date: 10/31/2014
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Revised: Standard Documentation Language to add covered prior to a beneficiary's Medicare eligibility
DOCUMENTATION REQUIREMENTS:
Revised: Standard Documentation Language to add who can enter date of delivery date on the PODA
dded: Instructions for Equipment Retained from a Prior Payer
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: Instructions for Recertification DIF

Policy Article
Revision Effective Date: 10/31/2014
CODING GUIDELINES:
Updated: Standard language documentation for PDAC coding verification

External Breast Prostheses
LCD
Revision Effective Date: 10/31/2014
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Revised: Standard Documentation Language to add covered prior to a beneficiary's Medicare eligibility
DOCUMENTATION REQUIREMENTS:
Moved: Continued Need above Continued Use documentation
Added: Instructions to the Refill Documentation section
Revised: Standard Documentation Language to add who can enter date of delivery date on the POD
Added: Equipment Retained from a Prior Payer

Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics)
LCD
Revision Effective Date: 10/31/2014
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Revised: Standard Documentation Language to add covered prior to a beneficiary's Medicare eligibility
Revised: 3-drug combination coverage - Akynzeo® (netupitant with palonosetron) NK-1/5HT3 antagonist available - effective on and after 10/10/2014
DOCUMENTATION REQUIREMENTS:
Revised: Standard Documentation Language to add who can enter date of delivery date on the POD
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: Akynzeo® to the 3-drug combination billing and modifier instructions, effective on and after 10/10/2014

Policy Article
Revision Effective Date: 10/31/2014
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: HCPCS Codes J8650, Q0161 – Q0180 to oral antiemetic drug coverage criteria
Revised: 3-drug combination regimen - Akynzeo® (netupitant with palonosetron) NK-1/5HT3 antagonist available - effective on and after 10/10/2014
CODING GUIDELINES:
Added: Akynzeo® (netupitant with palonosetron) NK-1/5HT3 antagonist available - effective on and after 10/10/2014

Parenteral Nutrition
LCD
Revision Effective Date: 10/31/2014
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Revised: Standard Documentation Language to add covered prior to a beneficiary's Medicare eligibility
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
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: Instructions for Recertification DIF

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 LCD and/or Policy Article.