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February 21, 2019

LCD and Policy Article Revisions Summary for February 21, 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: Automatic External Defibrillators, Glucose Monitors, Knee Orthoses, Lower Limb Prostheses, Mechanical In-exsufflation Devices, Nebulizers, Suction Pumps, Transcutaneous Electrical Nerve Stimulators (TENS), and Urological Supplies. Please review the entire LCDs and related PAs for complete information.

Automatic External Defibrillators

LCD

Automatic External Defibrillators 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 codes moved to LCD-related Policy Article noncovered diagnosis code section per CMS instruction

APPENDICES:

  • Revised: Reference to the applicable diagnosis code section

Policy Article

Automatic External Defibrillators Policy ArticleExternal Website

Revision Effective Date: 01/01/2019

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

02/21/2019: 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.

Glucose Monitors

LCD

Glucose Monitors 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 code section per CMS instruction

Policy Article

Glucose Monitors Policy ArticleExternal Website

Revision Effective Date: 01/01/2019

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 coded from coverage

02/21/2019: 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.

Knee Orthoses

LCD

Knee Orthoses 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 codes moved to LCD-related Policy Article noncovered diagnosis code section per CMS instruction

Policy Article

Knee Orthoses Policy ArticleExternal Website

Revision Effective Date: 01/01/2019

CODING GUIDELINES:

  • Revised: Coding instructions for prefabricated orthoses without distinction of OTS or custom-fit.
  • Revised: RT and LT modifier billing instructions (Effective 03/01/2019)

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 for specified HCPCS codes from coverage

02/21/2019: 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.

Lower Limb Prostheses

Policy Article

Lower Limb Prostheses Policy ArticleExternal Website

Revision Effective Date: 03/01/2019

CODING GUIDELINES:

  • Removed: L8505 from list of batteries billed concurrently with powered base, due to technical correction
  • Removed: L8505 from Column II of rebundling table, due to technical correction

02/21/2019: 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.

Mechanical In-exsufflation Devices

LCD

Mechanical In-exsufflation 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

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

Mechanical In-exsufflation Devices Policy ArticleExternal Website

Revision Effective Date: 01/01/2019

CODING GUIDELINES:

  • Added: E0467 Coding Guidelines

ICD-10 CODES THAT ARE COVERED:

  • Added: All diagnosis codes formerly listed in the LCD
  • Added: ICD-10 codes E74.02 and G70.01

ICD-10 CODES THAT ARE NOT COVERED:

  • Added: Notation excluding all unlisted diagnosis codes from coverage

02/21/2019: 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.

Nebulizers

LCD

Nebulizers LCDExternal Website

Revision Effective Date: 01/01/2019

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

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

Policy Article

Nebulizers Policy ArticleExternal Website

Revision Effective Date: 01/01/2019

CODING GUIDELINES:

  • Removed: E0571 Coding Guidelines
  • Added: E0467 Coding Guidelines

ICD-10 CODES THAT ARE COVERED:

  • Added: Diagnosis codes formerly listed in the LCD
  • Removed: I27.23 and I27.29 from Group 11 Codes due to conflict with coverage criteria

ICD-10 CODES THAT ARE NOT COVERED:

  • Added: Notation excluding unlisted diagnosis codes from coverage for specific HCPCS. Notation that all diagnosis codes are excluded from coverage for a specified list of HCPCS. Notation that for all other HCPCS codes, diagnosis codes are not specified.

02/21/2019: 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.

Suction Pumps

LCD

Suction 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

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

Suction Pumps Policy ArticleExternal Website

Revision Effective Date: 01/01/2019

CODING GUIDELINES:

  • Added: E0467 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 ICD-10 code G47.33 for HCPCS codes A7002, A7047 and E0600, for HCPCS A4605 and A4624 all ICD-10 codes not listed above, and for remaining HCPCS codes in this LCD the ICD-10 code not specified

02/21/2019: 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.

Transcutaneous Electrical Nerve Stimulators (TENS)

LCD

Transcutaneous Electrical Nerve Stimulators (TENS) 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 codes moved to LCD-related Policy Article noncovered diagnosis code section per CMS instruction

Policy Article

Transcutaneous Electrical Nerve Stimulators (TENS) Policy ArticleExternal Website

Revision Effective Date: 01/01/2019

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 ICD-10 codes not specified above for TENS used for CLBP. TENS for all other uses not specified 

02/21/2019: 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.

Urological Supplies

LCD

Urological Supplies 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 codes moved to LCD-related Policy Article noncovered diagnosis code section per CMS instruction

Policy Article

Urological Supplies Policy ArticleExternal Website

Revision Effective Date: 01/01/2019

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

02/21/2019: 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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