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February 28, 2019

LCD and Policy Article Revisions Summary for February 28, 2019

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, Orthopedic Footwear, Pneumatic Compression Devices, Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea, Pressure Reducing Support Surfaces - Group 2, Pressure Reducing Support Surfaces - Group 3, and Surgical Dressings. Please review the entire LCDs and related PAs for complete information.

Immunosuppressive Drugs

LCD

Immunosuppressive Drugs LCDExternal Website

Revision Effective Date: 01/01/2017

GENERAL DOCUMENTATION REQUIREMENTS:

  • Revised: Bullet spacing

Policy Article

Immunosuppressive Drugs Policy ArticleExternal Website

Revision Effective Date: 01/01/2019

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

  • Revised: Criterion V to allow drugs to be dispensed two days prior to discharge to the home
  • Removed: Statement regarding KX modifier

CODING INFORMATION:

  • Removed: Bill type code inadvertently added

02/28/2019: 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.

Orthopedic Footwear

LCD

Orthopedic Footwear 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

Orthopedic Footwear Policy ArticleExternal Website

Revision Effective Date: 01/01/2019

CODING GUIDELINES:

  • 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

02/28/2019: 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.

Pneumatic Compression Devices

LCD

Pneumatic Compression Devices LCDExternal Website

Revision Effective Date: 01/01/2019

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

  • Removed: All references to NCD 280.6
  • Added: Clarifying language to four-week trial for lymphedema under Group I, clarifying language to Group III coverage, and clarifying language to PCD code selection section

Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea

LCD

Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea LCDExternal Website

Revision Effective Date: 01/01/2019

ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:

  • Moved: Diagnosis code 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 SPECIFIC DOCUMENTATION REQUIREMENTS:

  • Revised: Appendix A - updated Epworth Sleepiness Scale reference to AMA format

Policy Article

Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea Policy ArticleExternal Website

Revision Effective Date: 01/01/2019

CODING GUIDELINES:

  • Added: E0467 Coding Guidelines

ICD-10 CODES THAT ARE COVERED:

  • Added: Diagnosis code formerly listed in the LCD

ICD-10 CODES THAT ARE NOT COVERED:

  • Added: Notation excluding all unlisted diagnosis codes from coverage

02/28/2019: 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.

Pressure Reducing Support Surfaces - Group 2

LCD

Pressure Reducing Support Surfaces - Group 2 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

Pressure Reducing Support Surfaces - Group 2 Policy ArticleExternal Website

Revision History 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

02/28/2019: 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.

Pressure Reducing Support Surfaces - Group 3

LCD

Pressure Reducing Support Surfaces - Group 3 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

Pressure Reducing Support Surfaces - Group 3 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

02/28/2019: 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.

Surgical Dressings

LCD

Surgical Dressings LCDExternal Website

Revision Effective Date: 01/01/2019

BIBLIOGRAPHY:

  • Removed: Bibliography from LCD

ASSOCIATED DOCUMENTS:

  • Added: Bibliography attachment

Policy Article

Surgical Dressings Policy ArticleExternal Website

Revision Effective Date: 01/01/2019

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

  • Revised: Qualifying wound wording to match language in the Benefit Policy Manual

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

  • Removed: Expected duration of need from order specifications

CODING GUIDELINES:

  • Revised: RT and/or LT modifier instructions

02/28/2019: 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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