Skip to Main Content

June 18, 2026

Policy Article Revisions Summary for June 18, 2026

Joint DME MAC Publication

Outlined below are the principal changes to the DME MAC Policy Articles (PAs) that have been revised and posted. The policies included are Lower Limb Prostheses and Nebulizers. Please review the entire Local Coverage Determinations (LCDs) and related PAs for complete information.

Lower Limb Prostheses

PA

Lower Limb Prostheses PAExternal Website

Revision Effective Date: 08/01/2026

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

  • Removed: K-level modifier information that pertained to claims submitted for knee, foot, ankle, and hip HCPCS codes
  • Revised: “This expectation of functional ability information must be clearly documented and retained in the prosthetist's records.” to “Functional ability information must be clearly documented and retained in the prosthetist's records.,” as clarification
  • Revised: “The simple entry of a K modifier in those records is not sufficient.” to “The simple entry of a K-level modifier in those records is not sufficient.,” as clarification

MODIFIERS:

  • Revised: “GA, GY, GZ, KX, LT, and RT MODIFIERS:” to “GA, GY, GZ, K0, K1, K2, K3, K4, KX, LT, and RT MODIFIERS:”
  • Added: “K-level modifiers are K0, K1, K2, K3, and K4. These modifiers are used to indicate the expected beneficiary functional level. Information to support the K-level modifier must be retained in the supplier’s files and available to the DME MAC upon request.,” as clarification
  • Added: K-level modifier information that pertains to claims submitted for knee, foot, ankle, and hip HCPCS codes (relocated from the POLICY SPECIFIC DOCUMENTATION REQUIREMENTS section)
  • Added: L5827 to the HCPCS codes that must be submitted with a K-level modifier, as clarification
  • Added: L5845, L5850, L5855, L5925, L5926, L5968, and L5988 as HCPCS codes that must be submitted with a K-level modifier (as of dates of service on or after 08/01/2026)
  • Added: “Claim lines billed for these lower limb prosthetic HCPCS codes without a K-level modifier will be rejected as missing information.,” as clarification

CODING GUIDELINES:

  • Revised: “Codes L5940, L5950, and L5960 for ultra-light materials may only be used when materials such as carbon fiber, fiberglass, Kevlar, or other advanced composite lamination materials are used in the fabrication of a socket for an endoskeletal prosthesis.” to “Codes L5940, L5950, and L5960 for ultra-light materials may only be used when materials such as carbon fiber, fiberglass, Kevlar, or other advanced composite lamination materials are used in the fabrication of a socket for an endoskeletal prosthesis (i.e., L5301, L5312, L5321, L5331, L5341, L5700, L5701, L5702, or L5703).,” as clarification
  • Revised: “microprocessor controlled knee” to “microprocessor-controlled knee”
  • Revised: "K-Level modifier” to “K-level modifier”
  • Revised: “Included features in the code are described by L5845 and L5848.” to “Features included in the code are described by L5845 and L5848.”
  • Revised: “The use of these codes can be used to fully describe additional features or functions not found in the prosthetic foot system (L5969, L5970, L5971, L5972, L5973, L5974, L5975, L5976, L5978, L5979 L5980, L5981 and L5987).” to “These codes can be used to fully describe additional features or functions not found in the prosthetic foot system (L5970, L5971, L5972, L5973, L5974, L5975, L5976, L5978, L5979, L5980, L5981, and L5987).,” as clarification
  • Revised: “Use of L5968, L5982, L5984 or L5986 is based on the beneficiary’s K-level modifier (K0-K4), as referenced in the LCD.” to “Use of L5982, L5984, L5985, or L5986 is based on the beneficiary’s K-level modifier (K0-K4), as referenced in the LCD.,” as clarification
  • Revised: “L5968, L5982, L5984, L5985, L5986, L5988, L5990 are additional features and/or functions that do not describe a complete prosthetic foot and may be used in combination with L5970, L5971, L5972, L5974, L5975, L5976, L5978, L5979, L5980, L5981, and L5987.” to “L5968, L5969, L5982, L5984, L5985, L5986, L5988, L5990 are additional features and/or functions that do not describe a complete prosthetic foot and may be used in combination with L5970, L5971, L5972, L5973, L5974, L5975, L5976, L5978, L5979, L5980, L5981, and L5987.,” as clarification
  • Revised: “microprocessor controlled foot” to “microprocessor-controlled foot”
  • Revised: “There is no separate payment for batteries (L7360, L7364, and L7367) and/or battery chargers (L7362, L7366, and L7368) billed concurrently with a powered base item.” to “There is no separate payment for batteries (L7360, L7364, and L7367) and/or battery chargers (L7362, L7366, and L7368) billed concurrently with a powered base item (L5781, L5782, L5856, L5857, L5858, L5859, and L5973).,” as clarification
  • Revised: The format of the table that pertains to items in Column II which are included in the payment for each Column I code, as clarification

06/18/2026: 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.

Nebulizers

PA

Nebulizers PAExternal Website

Revision Effective Date: 02/01/2026

ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY:

  • Added: ICD-10-CM codes Z90.02 and Z96.3 to Group 5 Codes

06/18/2026: 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.

spacer

26 Century Blvd, Suite NT600, Nashville, TN 37214 © CGS Administrators, LLC. All Rights Reserved