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February 14, 2019

LCD and Policy Article Revisions Summary for February 14, 2019

Outlined below are the principal changes to the DME MAC Local Coverage Determinations (LCDs) and Policy Articles that have been revised and posted. The policies included are: Cold Therapy, Enteral Nutrition, External Breast Prostheses, External Infusion Pumps, High Frequency Chest Wall Oscillation Devices, Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics), Oxygen and Oxygen Equipment, Spinal Orthoses: TLSO and LSO, and Wheelchair Options and Accessories. Please review the entire LCDs and related PAs for complete information.

Cold Therapy

LCD

Cold Therapy LCD External Website

Revision Effective Date: 01/01/2019

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

  • Revised: Code descriptor for E0218 from water to fluid

HCPCS CODES:

  • Revised: Code descriptor for A9273 from water to fluid and expanded to include cold or hot fluid
  • Revised: Code descriptor for E0218 from water to fluid

Policy Article

Cold Therapy Policy ArticleExternal Website

Revision Effective Date: 01/01/2019

CODING GUIDELINES:

  • Revised: Coding guidelines for A9270
  • Added: Coding guideline for A9273
  • Revised: Code descriptor for E0218 from water to fluid per annual HCPCS code update

02/14/2019: 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.

Enteral Nutrition

LCD

Enteral Nutrition LCDExternal Website

Revision Effective Date: 01/01/2019

HCPCS CODES:

  • Added: HCPCS B4105

Policy Article

Enteral Nutrition Policy ArticleExternal Website

Revision Effective Date: 01/01/2019

CODING GUIDELINES:

  • Revised: 'these supplies' to 'these supply allowances' for enteral feeding supplies
  • Added: In-Line Cartridge Coding Guidelines and billing instructions for Q9994 and B4105

02/14/2019: 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.

External Breast Prostheses

LCD

External Breast Prostheses LCDExternal Website

Revision Effective Date: 01/01/2019

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

  • Removed: Statement to refer to diagnosis code section below
  • Added: Refer to Covered ICD-10 Codes in the LCD-related Policy Article

ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:

  • Moved: All diagnosis codes to the LCD-related Policy Article diagnosis code section per CMS instruction

ICD-10 CODES THAT DO NOT SUPPORT MEDICAL NECESSITY:

  • Moved: Statement about noncovered diagnosis code moved to LCD-related Policy Article noncovered diagnosis section per CMS instruction.

Policy Article

External Breast Prostheses Policy ArticleExternal Website

Revision Effective Date: 01/01/2019

CODING GUIDELINES:

  • Added: Lycra to L8000 code description
  • Revised: RT and/or LT modifier instructions

ICD-10 CODES THAT ARE COVERED:

  • Added: All diagnosis codes formerly listed in the LCD

ICD-10 CODES THAT ARE NOT COVERED:

  • Added: Notation excluding all unlisted diagnosis codes from coverage

02/14/2019: 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.

External Infusion Pumps

LCD

External Infusion Pumps LCDExternal Website

Revision Effective Date: 01/01/2019

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

  • Removed: Statement to refer to diagnosis code section below
  • Added: Refer to Covered ICD-10 Codes in the LCD-related Policy Article
  • Revised: Effective for claims with dates of service on or after 03/29/2018 allow additional cycles of Blinatumomab (J9039)

HCPCS CODES:

  • Added: HCPCS codes G0068, G0069, and G0070 to Group 3 codes

ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:

  • Moved: All diagnosis codes to the LCD-related Policy Article diagnosis code section per CMS instruction

ICD-10 CODES THAT DO NOT SUPPORT MEDICAL NECESSITY:

  • Moved: Statement about noncovered diagnosis code moved to LCD-related Policy Article noncovered diagnosis section per CMS instruction

Policy Article

External Infusion Pumps Policy ArticleExternal Website

Revision Effective Date: 01/01/2019

CODING GUIDELINES:

  • Added: Professional services description

ICD-10 CODES THAT ARE COVERED:

  • Added: All diagnosis codes formerly listed in the LCD

ICD-10 CODES THAT ARE NOT COVERED:

  • Added: Notation excluding all unlisted diagnosis codes from coverage

02/14/2019: 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.

High Frequency Chest Wall Oscillation Devices

LCD

High Frequency Chest Wall Oscillation Devices LCDExternal Website

Revision Effective Date: 01/01/2019

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

  • Removed: Statement to refer to diagnosis code section below
  • Added: Refer to Covered ICD-10 Codes in the LCD-related Policy Article

HCPCS CODES:

  • Revised: Code descriptor for E0483

ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:

  • Moved: All diagnosis codes to the LCD-related Policy Article diagnosis code section per CMS instruction

ICD-10 CODES THAT DO NOT SUPPORT MEDICAL NECESSITY:

  • Moved: Statement about noncovered diagnosis codes moved to LCD-related Policy Article noncovered diagnosis code section per CMS instruction

Policy Article

High Frequency Chest Wall Oscillation Devices Policy ArticleExternal Website

Revision Effective Date: 01/01/2019

CODING GUIDELINES:

  • Revised: Code descriptor for E0483

ICD-10 CODES THAT ARE COVERED:

  • Added: All diagnosis codes formerly listed in the LCD

ICD-10 CODES THAT ARE COVERED:

  • Added: Notation excluding all unlisted diagnosis codes from coverage

02/14/2019: 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.

Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics)

LCD

Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) LCDExternal Website

Revision Effective Date: 01/01/2019

HCPCS CODES:

  • Added: "ORAL" to HCPCS code J8655

Policy Article

Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) Policy ArticleExternal Website

Revision Effective Date: 01/01/2019

CODING GUIDELINES:

  • Added: "ORAL" to HCPCS code J8655 code description

02/14/2019: 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.

Oxygen and Oxygen Equipment

LCD

Oxygen and Oxygen Equipment LCDExternal Website

Revision Effective Date: 01/01/2019

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

  • Removed: NCD language
  • Removed: Statement to refer to diagnosis code section below
  • Added: Refer to Covered ICD-10 Codes in the LCD-related Policy Article

HCPCS CODES:

  • Added: HCPCS E0447

ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:

  • Moved: All diagnosis codes to the LCD-related Policy Article diagnosis code section per CMS instruction

ICD-10 CODES THAT DO NOT SUPPORT MEDICAL NECESSITY:

  • Moved: Statement about noncovered diagnosis code moved to LCD-related Policy Article noncovered diagnosis code section per CMS instruction

Policy Article

Oxygen and Oxygen Equipment Policy ArticleExternal Website

Revision Effective Date: 01/01/2019

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

  • Added: E0447 to Oxygen Content guidelines

CODING GUIDELINES:

  • Added: E0467 Coding Guidelines
  • Revised: E1405 and E1406 Coding Guidelines

ICD-10 CODES THAT ARE COVERED:

  • Added: All diagnosis codes formerly listed in the LCD

ICD-10 CODES THAT ARE NOT COVERED:

  • Added: Notation excluding all unlisted diagnosis codes from coverage

02/14/2019: 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.

Spinal Orthoses: TLSO and LSO

Policy Article

Spinal Orthoses: TLSO and LSO Policy ArticleExternal Website

Revision Effective Date: 01/01/2019

CODING GUIDELINES:

  • Revised: Coding instructions for prefabricated orthoses without distinction of OTS or custom-fit.

02/14/2019: 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 and Accessories

LCD

Wheelchair Options and Accessories Policy LCDExternal Website

Revision Effective Date: 01/01/2019

HCPCS CODES:

  • Revised: K0037 narrative to remove "replacement only"

Policy Article

Wheelchair Options and Accessories Policy ArticleExternal Website

Revision Effective Date: 01/01/2019

CODING GUIDELINES:

  • Removed: K0037 from "replacement only" items
  • Revised: RT and LT modifier billing instructions (Effective 03/01/2019)

02/14/2019: 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 PAs. For complete information on any topic, you must review the LCDs and/or PAs.

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