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February 6, 2020

LCD and Policy Article Revisions Summary for February 6, 2020

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: Automatic External Defibrillators, Bowel Management Devices, Canes and Crutches, Cervical Traction Devices, Enteral Nutrition, External Breast Prostheses, Heating Pads and Heat Lamps, High Frequency Chest Wall Oscillation Devices, Hospital Beds And Accessories, Immunosuppressive Drugs, Intravenous Immune Globulin, and Mechanical In-exsufflation Devices. Please review the entire LCDs and related PAs for complete information.

Automatic External Defibrillators

LCD

Automatic External Defibrillators LCDExternal Website

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

  • Revised: "ordering physician" to "treating practitioner"
  • Removed: Statement to refer to ICD-10 Codes that are Covered section in the LCD-related PA
  • Added: Statement to refer to ICD-10 code section in the LCD-related Policy Article
  • Revised: Order information as a result of Final Rule 1713

GENERAL DOCUMENTATION REQUIREMENTS:

  • Revised: Prescriptions (orders) to SWO

APPENDICES:

  • Removed: Statement to refer to ICD-10 Codes that are Covered section in the LCD-related PA
  • Added: Statement to refer to ICD-10 code section in the LCD-related Policy Article

02/06/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713.

PA

Automatic External Defibrillators PAExternal Website

Revision Effective Date: 01/01/2020

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

  • Removed: REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO 42 CFR 410.38(g) section

REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 Fed. Reg Vol 217):

  • Added: Section and related information based on Final Rule 1713

CODING GUIDELINES:

  • Revised: Format of HCPCS code references, from code 'spans' to individually-listed HCPCS

ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:

  • Revised: Section header "ICD-10 Codes that are Covered" updated to "ICD-10 Codes that Support Medical Necessity"

ICD-10 CODES THAT DO NOT SUPPORT MEDICAL NECESSITY:

  • Revised: Section header "ICD-10 Codes that are Not Covered" updated to "ICD-10 Codes that DO NOT Support Medical Necessity"

02/06/2020: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Bowel Management Devices

LCD

Bowel Management Devices LCDExternal Website

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

  • Revised: Order information as a result of Final Rule 1713

GENERAL DOCUMENTATION REQUIREMENTS:

  • Revised: Prescriptions (orders) to SWO

02/06/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713.

PA

Bowel Management Devices PAExternal Website

Revision Effective Date: 01/01/2020

REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 Fed. Reg Vol 217):

  • Added: Section and related information based on Final Rule 1713

ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:

  • Revised: Section header "ICD-10 Codes that are Covered" updated to "ICD-10 Codes that Support Medical Necessity"

ICD-10 CODES THAT DO NOT SUPPORT MEDICAL NECESSITY:

  • Revised: Section header "ICD-10 Codes that are Not Covered" updated to "ICD-10 Codes that DO NOT Support Medical Necessity"

02/06/2020: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Canes and Crutches

LCD

Canes and Crutches LCDExternal Website

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

  • Revised: Format of HCPCS code references, from code spans to individually-listed HCPCS
  • Revised: Order information as a result of Final Rule 1713

GENERAL DOCUMENTATION REQUIREMENTS:

  • Revised: Prescriptions (orders) to SWO

02/06/2020: Pursuant to the 21st Century Cures Act , these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713, HCPCS code changes, and non-substantive corrections (listing individual HCPCS codes instead of a HCPCS code-span).

PA

Canes and Crutches PAExternal Website

Revision Effective Date: 01/01/2020

REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 Fed. Reg Vol 217):

  • Added: Section and related information based on Final Rule 1713

ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:

  • Revised: Section header "ICD-10 Codes that are Covered" updated to "ICD-10 Codes that Support Medical Necessity"

ICD-10 CODES THAT DO NOT SUPPORT MEDICAL NECESSITY:

  • Revised: Section header "ICD-10 Codes that are Not Covered" updated to "ICD-10 Codes that DO NOT Support Medical Necessity"

02/06/2020: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Cervical Traction Devices

LCD

Cervical Traction Devices LCDExternal Website

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

  • Revised: Format of HCPCS code references, from code spans to individually-listed HCPCS
  • Revised: "ordering physician" updated to "treating practitioner"

GENERAL:

  • Revised: Order information as a result of Final Rule 1713

GENERAL DOCUMENTATION REQUIREMENTS:

  • Revised: "Prescriptions (orders)" to "SWO"

02/06/2020: Pursuant to the 21st Century Cures Act , these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713, HCPCS code changes, and non-substantive corrections (listing individual HCPCS codes instead of a HCPCS code-span).

PA

Cervical Traction Devices PAExternal Website

Revision Effective Date: 01/01/2020

REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO 42 CFR 410.38(g):

  • Removed: Due to Final Rule 1713

REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 Fed. Reg Vol 217):

  • Added: Section information based on Final Rule 1713

ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:

  • Revised: Section header "ICD-10 Codes that are Covered" updated to "ICD-10 Codes that Support Medical Necessity"

ICD-10 CODES THAT DO NOT SUPPORT MEDICAL NECESSITY:

  • Revised: Section header "ICD-10 Codes that are Not Covered" updated to "ICD-10 Codes that DO NOT Support Medical Necessity"

02/06/2020: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Enteral Nutrition

LCD

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

  • Revised: Format of HCPCS code references, from code 'spans' to individually-listed HCPCS
  • Revised: Order information as a result of Final Rule 1713

REFILL REQUIREMENTS:

  • Revised: "ordering physician" to "treating practitioner"

DOCUMENTATION REQUIREMENTS:

  • Revised: "physician's" to "treating practitioner's"

GENERAL DOCUMENTATION REQUIREMENTS:

  • Revised: Prescriptions (orders) to SWO

02/06/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713, HCPCS code changes, and non-substantive corrections (listing individual HCPCS codes instead of a HCPCS code-span).

PA

Revision Effective Date: 01/01/2020

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

  • Revised: "attending physician" to "treating practitioner"
  • Revised: Format of HCPCS code references, from code 'spans' to individually-listed HCPCS

REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 Fed. Reg Vol 217):

  • Added: Section and related information based on Final Rule 1713

DME INFORMATION FORM (DIF):

  • Revised: "ordering physician" to "treating practitioner"
  • Revised: Format of HCPCS code references, from code 'spans' to individually-listed HCPCS

CODING GUIDELINES:

  • Revised: Format of HCPCS code references, from code 'spans' to individually-listed HCPCS

ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:

  • Revised: Section header "ICD-10 Codes that are Covered" updated to "ICD-10 Codes that Support Medical Necessity"

ICD-10 CODES THAT DO NOT SUPPORT MEDICAL NECESSITY:

  • Revised: Section header "ICD-10 Codes that are Not Covered" updated to "ICD-10 Codes that DO NOT Support Medical Necessity"

02/06/2020: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

External Breast Prostheses

LCD

External Breast Prostheses LCDExternal Website

Revision Effective Date: 01/01/2020

GENERAL:

  • Revised: Order information as a result of Final Rule 1713

REFILL REQUIREMENTS:

  • Revised: "ordering physician" to "treating practitioner"

GENERAL DOCUMENTATION REQUIREMENTS:

  • Revised: "Prescriptions (orders)" to "SWO"

02/06/2020: Pursuant to the 21st Century Cures Act , these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713.

PA

External Breast Prostheses PAExternal Website

Revision Effective Date: 01/01/2020

REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 Fed. Reg Vol 217):

  • Added: Section and related information based on Final Rule 1713

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

  • Revised: "physician" to "treating practitioner"

02/06/2020: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Heating Pads and Heat Lamps

LCD

Heating Pads and Heat Lamps LCDExternal Website

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

  • Revised: Order information as a result of Final Rule 1713

GENERAL DOCUMENTATION REQUIREMENTS:

  • Revised: Prescriptions (orders) to SWO

02/06/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713.

PA

Heating Pads and Heat Lamps PAExternal Website

Revision Effective Date: 01/01/2020

REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 Fed. Reg Vol 217):

  • Added: Section and related information based on Final Rule 1713

ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:

  • Revised: Section header "ICD-10 Codes that are Covered" updated to "ICD-10 Codes that Support Medical Necessity"

ICD-10 CODES THAT DO NOT SUPPORT MEDICAL NECESSITY:

  • Revised: Section header "ICD-10 Codes that are Not Covered" updated to "ICD-10 Codes that DO NOT Support Medical Necessity"

02/06/2020: At this time 21st Century Cures Act applies to new and revised LCDs 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

High Frequency Chest Wall Oscillation Devices LCDExternal Website

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

  • Removed: Statement to refer to ICD-10 Codes that are Covered section in the LCD-related PA
  • Added: Statement to refer to ICD-10 code list in the LCD-related Policy Article
  • Revised: Order information as a result of Final Rule 1713

GENERAL DOCUMENTATION REQUIREMENTS:

  • Revised: Prescriptions (orders) to SWO

02/06/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713.

PA

High Frequency Chest Wall Oscillation Devices PAExternal Website

Revision Effective Date: 01/01/2020

REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO 42 CFR 410.38(g):

  • Removed: Statement that the diagnosis code, that justifies the need for the items, must be billed on the claim
  • Removed: Section due to Final Rule 1713

REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 Fed. Reg Vol 217):

  • Added: Section and related information based on Final Rule 1713

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

  • Added: Statement that the diagnosis code, that justifies the need for the items, must be billed on the claim

ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:

  • Revised: Section header "ICD-10 Codes that are Covered" updated to "ICD-10 Codes that Support Medical Necessity"

ICD-10 CODES THAT DO NOT SUPPORT MEDICAL NECESSITY:

  • Revised: Section header "ICD-10 Codes that are Not Covered" updated to "ICD-10 Codes that DO NOT Support Medical Necessity"

02/06/2020: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Hospital Beds And Accessories

LCD

Hospital Beds And Accessories LCDExternal Website

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

  • Revised: Order information as a result of Final Rule 1713

DOCUMENTATION REQUIREMENTS:

  • Revised: "physician's" to "treating practitioner's"

GENERAL DOCUMENTATION REQUIREMENTS:

  • Revised: "Prescriptions (orders)" to "SWO"

02/06/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713.

PA

Hospital Beds And Accessories PAExternal Website

Revision Effective Date: 01/01/2020

REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO 42 CFR 410.38(g):

  • Removed: Due to Final Rule 1713

REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 Fed. Reg Vol 217):

  • Added: Section information based on Final Rule 1713

ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:

  • Revised: Section header "ICD-10 Codes that are Covered" updated to "ICD-10 Codes that Support Medical Necessity"

ICD-10 CODES THAT DO NOT SUPPORT MEDICAL NECESSITY:

  • Revised: Section header "ICD-10 Codes that are Not Covered" updated to "ICD-10 Codes that DO NOT Support Medical Necessity"

02/06/2020: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Immunosuppressive Drugs

LCD

Immunosuppressive Drugs LCDExternal Website

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

  • Revised: "physician" to "treating practitioner"

GENERAL:

  • Revised: Order information as a result of Final Rule 1713

REFILL REQUIREMENTS:

  • Revised: "ordering physician" to "treating practitioner"

DOCUMENTATION REQUIREMENTS:

  • Revised: "physician's" to "treating practitioner's"

GENERAL DOCUMENTATION REQUIREMENTS:

  • Revised: Prescriptions (orders) to SWO

02/06/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713.

PA

Immunosuppressive Drugs PAExternal Website

Revision Effective Date: 01/01/2020

REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 Fed. Reg Vol 217):

  • Added: Section and related information based on Final Rule 1713

MODIFIERS:

  • Revised: "ordering physician" to "treating practitioner"

ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:

  • Revised: Section header "ICD-10 Codes that are Covered" updated to "ICD-10 Codes that Support Medical Necessity"

ICD-10 CODES THAT DO NOT SUPPORT MEDICAL NECESSITY:

  • Revised: Section header "ICD-10 Codes that are Not Covered" updated to "ICD-10 Codes that DO NOT Support Medical Necessity"

02/06/2020: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Intravenous Immune Globulin

LCD

Intravenous Immune Globulin LCDExternal Website

Revision Effective Date: 01/01/2020

GENERAL:

  • Revised: Order information as a result of Final Rule 1713

REFILL REQUIREMENTS:

  • Revised: "ordering physicians" to "treating practitioners"

DOCUMENTATION REQUIREMENTS:

  • Revised: "physician's" to "treating practitioner's"

GENERAL DOCUMENTATION REQUIREMENTS:

  • Revised: "Prescriptions (orders)" to "SWO"

02/06/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713.

PA

Intravenous Immune Globulin PAExternal Website

Revision Effective Date: 01/01/2020

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

  • Revised: "physician" to "practitioner"

REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 Fed. Reg Vol 217):

  • Added: Section and related information based on Final Rule 1713

ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:

  • Revised: Section header "ICD-10 Codes that are Covered" updated to "ICD-10 Codes that Support Medical Necessity"

ICD-10 CODES THAT DO NOT SUPPORT MEDICAL NECESSITY:

  • Revised: Section header "ICD-10 Codes that are Not Covered" updated to "ICD-10 Codes that DO NOT Support Medical Necessity"

02/06/2020: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Mechanical In-exsufflation Devices

LCD

Mechanical In-exsufflation Devices LCDExternal Website

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

  • Removed: Statement to refer to ICD-10 Codes that are Covered section in the LCD-related PA
  • Added: Statement to refer to ICD-10 code list in the LCD-related Policy Article

GENERAL:

  • Revised: Order information as a result of Final Rule 1713

DOCUMENTATION REQUIREMENTS:

  • Revised: "physician's" to "treating practitioner's"

GENERAL DOCUMENTATION REQUIREMENTS:

  • Revised: "Prescriptions (orders)" to "SWO"

02/06/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713.

PA

Mechanical In-exsufflation Devices PAExternal Website

Revision Effective Date: 01/01/2020

REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO 42 CFR 410.38(g):

  • Removed: Due to Final Rule 1713

REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 Fed. Reg Vol 217):

  • Added: Section information based on Final Rule 1713

ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:

  • Revised: Section header "ICD-10 Codes that are Covered" updated to "ICD-10 Codes that Support Medical Necessity"

ICD-10 CODES THAT DO NOT SUPPORT MEDICAL NECESSITY:

  • Revised: Section header "ICD-10 Codes that are Not Covered" updated to "ICD-10 Codes that DO NOT Support Medical Necessity"

02/06/2020: At this time 21st Century Cures Act applies to new and revised LCDs 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.

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