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May 2, 2024

LCD and Policy Article Revisions Summary for May 2, 2024

Joint DME MAC Publication

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 Glucose Monitors, Immunosuppressive Drugs, Lower Limb Prostheses, Walkers and Wheelchair Options/Accessories. Please review the entire LCDs and related PAs for complete information.

Glucose Monitors

Glucose Monitors LCDExternal Website

LCD

Revision Effective Date: 04/01/2024

HCPCS CODES:

  • Added: Codes E2104 to Group 1 Codes and A4271 to Group 2 Codes

05/02/2024: 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

Glucose Monitors PAExternal Website

Revision Effective Date: 04/01/2024

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

  • Added: Codes E2104 and A4271 to "Code A4238 does not include a home BGM (HCPCS codes E0607, E2100, E2101, E2104) and related BGM testing supplies (HCPCS codes A4233, A4234, A4235, A4236, A4244, A4245, A4246, A4247, A4250, A4253, A4255, A4256, A4257, A4258, A4259, A4271)."

MODIFIERS:

  • Added: Codes E2104 and A4271

CODING GUIDELINES:

  • Added: Codes E2100, E2101 and E2104 to home BGMs
  • Revised: "The test strips may be separate items that are inserted into the monitor or self-contained in a cylinder or disk-type mechanism." to "The test strips/test reagents may be separate items that are inserted into the monitor or self-contained in a cartridge or disk-type mechanism."
  • Added: "In addition, the lancing device and lancets may be separate items or integrated into a cartridge or other similar integrated mechanism."
  • Revised: "BGMs with integrated voice synthesizers (code E2100) are devices that measure capillary whole blood for determination of blood glucose levels. Results are displayed on a screen but are also digitalized and converted to sound output." to "Code E2100 describes a blood glucose monitor with an integrated voice synthesizer. Results are displayed on a screen and are digitized and converted to sound output."
  • Revised: "BGMs with integrated lancing and/or blood sampling (code E2101) are devices that measure capillary whole blood for determination of blood glucose levels." to "Codes E2101 and E2104 describe blood glucose monitors with an integrated lancing and/or blood sampling mechanism."
  • Added: "Code A4271 describes a cartridge with integrated lancing and blood sample testing sufficient to perform ten (10) blood glucose tests. The "per month" HCPCS descriptor represents one (1) unit of service (UOS) of code A4271 and is equivalent to 100 test strips and 100 lancets."
  • Added: Code E2104 to Column I and A4233, A4234, A4235, A4236 to corresponding Column II

ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY:

  • Added: ICD-10-CM codes E11.10 and E11.11 to Group 1 Codes (Effective for claims with dates of service on or after October 1, 2017)

05/02/2024: 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.

Immunosuppressive Drugs

Immunosuppressive Drugs LCDExternal Website

LCD

Revision Effective Date: 04/01/2024

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

  • Added: J2919 as methylprednisolone HCPCS code
  • Removed: J2920 and J2930 as methylprednisolone HCPCS codes

HCPCS CODES:

  • Added: HCPCS code J2919
  • Removed: HCPCS codes J2920 and J2930
  • Revised: HCPCS J7516 narrative from "CYCLOSPORIN, PARENTERAL, 250 MG" to "INJECTION, CYCLOSPORINE, 250 MG"

05/02/2024: 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.

Lower Limb Prostheses

Lower Limb Prostheses LCDExternal Website

LCD

Revision Effective Date: 04/01/2024

HCPCS CODES:

  • Added: HCPCS codes L5841 and L5783

05/02/2024: 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

Lower Limb Prostheses PAExternal Website

Revision Effective Date: 04/01/2024

CODING GUIDELINES:

  • Added: HCPCS code L5783 coding guideline information

05/02/2024: 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.

Walkers

PA

Walkers PAExternal Website

Revision Effective Date: 04/01/2024

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

  • Added: "A powered walker (E0152) is noncovered as it does not meet the definition of DME."

05/02/2024: 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.

Wheelchair Options/Accessories

LCD

Wheelchair Options/Accessories LCDExternal Website 

Revision Effective Date: 04/01/2024

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

  • Removed: "(E2300)" from language pertaining to power seat elevation systems
  • Added: "(E2298)" to language pertaining to power seat elevation systems

HCPCS CODES:

  • Removed: E2300 from Group 6 Codes
  • Added: E2298 to Group 6 Codes

05/02/2024: 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

Wheelchair Options/Accessories PAExternal Website

Revision Effective Date: 04/01/2024

CODING GUIDELINES:

  • Revised: "(E2300)" to "(E2300 or E2298 depending on DOS - See below)"
  • Added: Information pertaining to coding of seat elevation systems on claims for DOS on or before March 31, 2024 and on or after April 1, 2024

05/02/2024: 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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