LCD and Policy Article Revisions Summary for November 30 2017 - JD DME

Outlined below are the principal changes to the DME MAC External Infusion Pumps, High Frequency Chest Wall Oscillation Devices and Transcutaneous Electrical Nerve Stimulators (TENS) Local Coverage Determinations (LCD) and Policy Articles (PA) that have been revised and posted. Please review the entire LCDs and related PAs for complete information.

External Infusion Pumps
LCD
Revision Effective Date: 07/11/2017
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Added: Expanded coverage for adult and pediatric patients with relapsed or refractory (R/R) B-cell precursor acute lymphoblastic leukemia (ALL)
Revised: Clarified 875 UOS equals 25 vials per month
HCPCS Code:
Added: J1555 (Effective 01/01/2018)
ICD-10 Codes that Support Medical Necessity:
Added: C91.00 to Group 5 coverage

11/30/2017: 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: 07/11/2017

CODING GUIDELINES:
Revised: Clarified blinatumomab USO, and added instructions for a 7-day infusion protocol
Revised: Added HCPCS code J1555 for CUVITRU effective for claims on or after 01/01/2018

11/30/2017: 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.

High Frequency Chest Wall Oscillation Devices
LCD
Revision Effective Date: 10/01/2017
ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:
Added: New ICD-10 codes
Revised: ICD-10 code descriptions

11/30/2017: 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: 01/01/2017
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PERSUANT TO 42 CFR 410.38(g), previously in the Policy Specific Documentation Requirements section.

11/23/17: 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.

Transcutaneous Electrical Nerve Stimulators (TENS)
LCD
Revision Effective Date: 10/01/2017
ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:
Added: New ICD-10 codes
Deleted: Non-valid ICD-10 (effective 10/01/2015)

11/30/2017: 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.

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.