LCD and Policy Article Revisions Summary for May 18, 2017

Posted on May 18, 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 Glucose Monitors, Suction Pumps and Transcutaneous Electrical Nerve Stimulators (TENS). Please review the entire LCD and related PA for complete information.

Glucose Monitors
LCD
Revision Effective Date: 01/12/2017

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

Removed: Standard Documentation Language

Added: New reference language and Directions to Standard Documentation Requirements

Revised: Coverage criteria for home blood glucose monitors

Added: Documentation requirements for home blood glucose monitors

Added: Coverage criteria for continuous glucose monitors and supply allowance

Added: Documentation requirements for continuous glucose monitors

Added: General Requirements

Revised: Refill requirements

Added: HCPCS codes for therapeutic CGM (K0554) and supply allowance (K0553) out of sequence to allow early publishing of codes and narratives. (For dates of service on or after 07/01/2017)

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: Directions to Standard Documentation Requirements

Removed: PIM reference under Appendices

RELATED LOCAL COVERAGE DOCUMENTS:

Added: LCD-related Standard Documentation Requirements article

Policy Article
Revision Effective Date: 01/12/2017

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

Added: Coverage and benefit category statements about continuous glucose monitors and supply allowance

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

Added: 42 CFR 410.38(g) and modifiers

Added: CG modifier use

CODING GUIDELINES

Added: For dates of service on or after 7/1/17, HCPCS codes for therapeutic CGM (K0554) and supply allowance (K0553)

Added: Definitions for continuous glucose monitor and supply allowance

Revised: Bundling table to include continuous glucose monitors and supply allowance

Added: PDAC coding verification review for CGM systems

RELATED LOCAL COVERAGE DOCUMENTS:

Added: LCD-related Standard Documentation Requirements Language Article

 

Suction Pumps
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 under Miscellaneous

Removed: PIM citation 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: Billing requirements

RELATED LOCAL COVERAGE DOCUMENTS:

Added: LCD-related Standard Documentation Requirements Language Article

 

Transcutaneous Electrical Nerve Stimulators (TENS)
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 under 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

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

Added: 42 CFR 410.38(g)

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

Added: Coverage criteria information, CMN and Modifier requirements

RELATED LOCAL COVERAGE DOCUMENTS:

Added: LCD-related Standard Documentation Requirements Language Article

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 Fri, 26 Oct 2018 15:45:44 +0000