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June 15, 2023

LCD and Policy Article Revisions Summary for June 15, 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 External Infusion Pumps, Intravenous Immune Globulin, Nebulizers and Standard Documentation Requirements for All Claims Submitted to DME MACs. Please review the entire LCDs and related PAs for complete information.

External Infusion Pumps

LCD

External Infusion Pumps LCDExternal Website

Revision Effective Date: 04/01/2023

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

  • Added: Instructions to DRUG WASTAGE section to see MODIFIERS section of LCD-related Policy Article (effective 01/01/2023)
  • Removed: JW and JZ modifier instructions from DRUG WASTAGE section (effective 01/01/2023)

06/15/2023: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates per CMS HCPCS coding determinations.

PA

External Infusion Pumps PAExternal Website

Revision Effective Date: 04/01/2023

MODIFIERS:

  • Revised: JW and JZ modifier instructions to align with the CMS 2023 Physician Fee Schedule final rule (effective 01/01/2023)

06/15/2023: 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.

Intravenous Immune Globulin

LCD

Intravenous Immune Globulin LCDExternal Website

Revision Effective Date: 01/01/2023

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

  • Added: Instructions to DRUG WASTAGE section to see MODIFIERS section of the LCD-related Policy Article
  • Removed: JW and JZ modifier instructions from DRUG WASTAGE section

06/15/2023: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates per CMS HCPCS coding determinations.

PA

Intravenous Immune Globulin PAExternal Website

Revision Effective Date: 01/01/2023

MODIFIERS:

  • Revised: JW and JZ modifier instructions to align with the CMS 2023 Physician Fee Schedule final rule

06/15/2023: 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.

Nebulizers

LCD

Nebulizers LCDExternal Website

Revision Effective Date: 01/01/2023

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

  • Added: Instructions to DRUG WASTAGE section to see MODIFIERS section of the LCD-related Policy Article
  • Removed: JW and JZ modifier instructions from DRUG WASTAGE section

06/15/2023: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates per CMS HCPCS coding determinations.

PA

Nebulizers PAExternal Website

Revision Effective Date: 01/01/2023

MODIFIERS:

  • Revised: JW and JZ modifier instructions to align with the CMS 2023 Physician Fee Schedule final rule

06/15/2023: 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.

Standard Documentation Requirements for All Claims Submitted to DME MACs

PA

Standard Documentation Requirements for All Claims Submitted to DME MACs PAExternal Website

Revision Effective Date: 01/01/2023

ORDERS:

  • Revised: Reference to “1861(r)(1)” which refers to physicians by removing “(1)” to reflect the full statutory definition of treating practitioner

WRITTEN ORDERS PRIOR TO DELIVERY (WOPD):

  • Added: Statutory definition of treating practitioner for PMDs

FACE-TO-FACE ENCOUNTER:

  • Removed: “For example, the National Coverage Determination § 240.2 “Home use of Oxygen” requires a face-to-face examination within a month of starting home oxygen therapy.” (effective 09/27/2021)

06/15/2023: 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.

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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