LCD and Policy Article Revisions Summary for May 14, 2015

Outlined below are the principal changes to DME MAC Local Coverage Determinations (LCDs) and Policy Articles (PAs) that have been revised and posted.  The policies included are Glucose Monitor, Pneumatic Compression Devices, Respiratory Assist Devices, Wheelchair Options/Accessories, and Wheelchair Seating. Please review each entire LCD and each related PA for complete information.

Glucose Monitor

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

Pneumatic Compression Devices

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:

Replaced: WOPD with ACA 6407 WOPD instructions

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: Standard Language Documentation verbiage for CMN

Added: Repair/Replacement section

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

Respiratory Assist Devices

LCD

Revision Effective Date: 12/01/2014 (May 2015 Publication)

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

Added: Repair/Replacement section

Policy Article

Revision Effective Date: 12/01/2014 (May 2015 Publication)

NON-MEDICAL NECESSITY COVERAGE & PAYMENT RULES:

Added: Non-coverage statement for liners used in conjunction with a PAP mask

Removed: "When required by state law" from ACA new prescription requirements

CODING GUIDELINES:

Added: Coding guidelines for liners used with PAP mask based on DME MAC article posted on February 13, 2014

Added: Coding guidelines for Monitoring Technology based on DME MAC article posted on November 15, 2013

Wheelchair Options/Accessories

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

Added: HCPCS Codes E2358 and E2359 to the Batteries/Chargers section

DOCUMENTATION REQUIREMENTS:

Deleted: Reference to refill of supplies from Continued Use

Revised: Standard Documentation Language to add who can enter date of delivery date on the POD

Added: Repair/Replacement section

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

CODING GUIDELINES:

Revised: Removed HCPCS K0017 and K0018 from the initial package verbiage for armrest separate billing due to being parts of the whole assembly E0973 and only separately billed for replacement parts

Added: E0973 was added to the initial package verbiage for armrest separate billing due to being the whole assembly

Removed: The word "adjustable" was removed from the initial package verbiage for armrest separate billing due to fixed armrests K0020 being included

Wheelchair Seating 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:

Deleted: Reference to refill of supplies from Continued Use

Revised: Standard Documentation Language to add who can enter date of delivery date on the POD

Added: Repair/Replacement section

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

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.

Last Updated Tue, 06 Sep 2016 09:03:49 +0000