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May 18, 2023

LCD and Policy Article Revisions Summary for May 18, 2023

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 Enteral Nutrition, Osteogenesis Stimulators, Parenteral Nutrition and Seat Lift Mechanisms. Please review the entire LCDs and related PAs for complete information.

Enteral Nutrition

LCD

Enteral Nutrition LCDExternal Website

Revision Effective Date: 07/02/2023

SUMMARY OF EVIDENCE:

  • Added: Information related to GA, GY, GZ, and KX modifier addition

ANALYSIS OF EVIDENCE:

  • Added: Information related to GA, GY, GZ, and KX modifier addition

CODING INFORMATION:

  • Added: GA, GY, GZ, and KX modifiers

RELATED LOCAL COVERAGE DOCUMENTS:

  • Added: Response to Comments (A59397)

PA

Enteral Nutrition PAExternal Website

Revision Effective Date: 07/02/2023

MODIFIERS:

  • Added: Section header
  • Added: BA, BO, GA, GY, GZ, and KX modifier instructions
  • Added: "As of January 1, 2023, suppliers must calculate the units of service (UOS) for each enteral product billed to Medicare, based on the treating practitioner's order."
  • Added: "Claim lines billed with codes without a KX, GA, GY or GZ modifier will be rejected as missing information" for claims with dates of service on or after July 2, 2023

CODING GUIDELINES:

  • Removed: "As of January 1, 2023, suppliers must calculate the units of service (UOS) for each enteral product billed to Medicare, based on the treating practitioner's order."
  • Removed: BA and BO modifier instructions

05/18/2023: 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.

Osteogenesis Stimulators

LCD

Osteogenesis Stimulators LCDExternal Website

Revision Effective Date: 07/02/2023

SUMMARY OF EVIDENCE:

  • Added: Information related to GA, GZ, and KX modifier addition

ANALYSIS OF EVIDENCE:

  • Added: Information related to GA, GZ, and KX modifier addition

CODING INFORMATION:

  • Added: GA, GZ and KX modifiers

RELATED LOCAL COVERAGE DOCUMENTS:

  • Added: Response to Comments (A59402)

PA

Osteogenesis Stimulators PAExternal Website

Revision Effective Date: 07/02/2023

MODIFIERS:

  • Added: GA, GZ, KX modifier instructions
  • Added: "Claim lines billed with codes without a KX, GA or GZ modifier will be rejected as missing information" for claims with dates of service on or after July 2, 2023

05/18/2023: At this time the 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.

Parenteral Nutrition

LCD

Parenteral Nutrition LCDExternal Website

Revision Effective Date: 07/02/2023

SUMMARY OF EVIDENCE:

  • Added: Information related to GA, GY, GZ, and KX modifier addition

ANALYSIS OF EVIDENCE:

  • Added: Information related to GA, GY, GZ, and KX modifier addition

CODING INFORMATION:

  • Added: GA, GY, GZ and KX modifiers

RELATED LOCAL COVERAGE DOCUMENTS:

  • Added: Response to Comments (A59399)

PA

Parenteral Nutrition PAExternal Website

Revision Effective Date: 07/02/2023

MODIFIERS:

  • Added: Section header
  • Added: BA, GA, GY, GZ, and KX modifier instructions
  • Added: "Claim lines billed with codes without a KX, GA, GY or GZ modifier will be rejected as missing information" for claims with dates of service on or after July 2, 2023

CODING GUIDELINES:

  • Removed: BA modifier instructions

05/18/2023: At this time the 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.

Seat Lift Mechanisms

LCD

Seat Lift Mechanisms LCDExternal Website

Revision Effective Date: 07/02/2023

SUMMARY OF EVIDENCE:

  • Added: Information related to GA, GZ, and KX modifier addition

ANALYSIS OF EVIDENCE:

  • Added: Information related to GA, GZ, and KX modifier addition

CODING INFORMATION:

  • Added: GA, GZ and KX modifiers

RELATED LOCAL COVERAGE DOCUMENTS:

  • Added: Response to Comments (A59403)

PA

Seat Lift Mechanisms PAExternal Website

Revision Effective Date: 07/02/2023

MODIFIERS:

  • Added: Section header
  • Added: GA, GZ, KX modifier instructions
  • Added: "Claim lines billed with codes without a KX, GA or GZ modifier will be rejected as missing information" for claims with dates of service on or after July 2, 2023

05/18/2023: At this time the 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/or PAs. For complete information on any topic, you must review the LCDs and/or PAs.

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