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January 8, 2026

LCD and Policy Article Revisions Summary for January 8, 2026

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 Immunosuppressive Drugs, Oral Anticancer Drugs, Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics), and Urological Supplies. Please review the entire LCDs and PAs for complete information.

Immunosuppressive Drugs

LCD

Immunosuppressive Drugs LCDExternal Website

Revision Effective Date: 01/01/2026

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

  • Removed: HCPCS codes J7505 and J7513 from section

HCPCS CODES:

  • Added: HCPCS code J7528 to Group 1 Codes
  • Removed: HCPCS codes J7505 and J7513 from Group 1 Codes

01/08/2026: 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.

Oral Anticancer Drugs

LCD

Oral Anticancer Drugs LCDExternal Website

Revision Effective Date: 01/01/2026

NATIONAL DRUG CODES (NDC):

  • Removed: Fludarabine phosphate from NDC listing

01/08/2026: 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

Oral Anticancer Drugs PAExternal Website

Revision Effective Date: 01/01/2026

ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY:

  • Removed: Group 5 Paragraph for Fludarabine Phosphate
  • Removed: Group 5 Codes
  • Revised: Subsequent groups re-numbered due to Group 5 removal

01/08/2026: 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.

Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics)

LCD

Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) LCDExternal Website

Revision Effective Date: 01/01/2026

HCPCS CODES:

  • Removed: HCPCS codes J8650 and Q0174 from Group 1 Codes

01/08/2026: 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

Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) PAExternal Website

Revision Effective Date: 01/01/2026

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

  • Removed: HCPCS codes J8650 and Q0174 from coverage direction

CODING GUIDELINES:

  • Removed: HCPCS codes J8650 and Q0174

01/08/2026: 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.

Urological Supplies

LCD

Urological Supplies LCDExternal Website

Revision Effective Date: 01/01/2026

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

  • Revised: “Intermittent catheterization using a sterile intermittent catheter kit (A4297, A4353) is covered when the beneficiary requires catheterization and the beneficiary meets one of the following criteria (1-5):” to “Intermittent catheterization using a sterile intermittent catheter kit (A4297, A4353) is covered when the beneficiary requires catheterization and the beneficiary meets one of the following criteria (1-4):,” to match the number of criteria listed

HCPCS CODES:

  • Revised: Location of A4295, A4296, A4297, A4351 and A4352 information, moving the information from Group 1 Paragraph text to Group 1 Codes HCPCS list

01/08/2026: 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 and a non-substantive update to resolve a typographical error.

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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