LCD and Policy Article Revisions Summary for June 7 2018 - JD DME
LCD and Policy Article Revisions Summary for June 7, 2018
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 External Infusion Pumps, and Oxygen & Oxygen Equipment. Please review the entire LCDs and related PAs for complete information.
External Infusion Pumps
LCD
Revision Effective Date: 03/29/2018
COVERAGE, INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Added: Expanded Coverage Indications for Blinatumomab
CODING INFORMATION:
Added: ICD-10 code to Group 5
06/07/2018: At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.
PA
Revision Effective Date: 01/01/2018
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: Clarified claims adjudication of pumps when an infusion is started in the physician's office
06/07/2018: At this time 21st Century Cures Act applies to new and revised LCDs that restrict coverage, which require comment and notice. This revision is to an article that is not a local coverage determination.
Oxygen and Oxygen Equipment
LCD
Revision Effective Date: 08/01/2018
HCPCS MODIFIERS:
Added: Modifier GA, GY, GZ, KX
06/07/2018: At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.
PA
Revision History Effective Date: 08/01/2018
CERTIFICATE OF MEDICAL NECESSITY (CMN):
Removed: Flow rate instructions when answering CMN question 5
MODIFIERS:
Added: GA, GY, GZ, and KX modifier requirement instructions
Added: "Q" modifier instructions
06/07/2018: At this time 21st Century Cures Act applies to new and revised LCDs that restrict coverage, which require comment and notice. This revision is to an article that is not a local coverage determination.
Note: The information contained in this article is only a summary of revisions to the LCDs and PAs. For complete information on any topic, you must review the LCDs and/or PAs.
