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March 28, 2019

LCD and Policy Article Revisions Summary for March 28, 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: Ankle-Foot/Knee-Ankle-Foot Orthosis, Knee Orthoses, Parenteral Nutrition and Spinal Orthoses: TLSO and LSO. Please review the entire LCDs and related PAs for complete information.

Ankle-Foot/Knee-Ankle-Foot Orthosis

LCD

Ankle-Foot/Knee-Ankle-Foot Orthosis 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

Ankle-Foot/Knee-Ankle-Foot Orthosis Policy ArticleExternal Website

Revision Effective Date: 01/01/2019

CODING GUIDELINES:

  • Clarified: Custom fit requirements
  • 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 unlisted diagnosis codes from coverage for specific HCPCS codes. Notation that for all other HCPCS codes, diagnoses are not specified.

03/28/2019: 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.

Knee Orthoses

Policy Article

Knee Orthoses Policy ArticleExternal Website

Revision Effective Date: 01/01/2019

CODING GUIDELINES:

  • Clarified: Custom fit requirements

03/28/2019: 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.

Parenteral Nutrition

Policy Article

Parenteral Nutrition Policy ArticleExternal Website

Revision Effective Date: 01/01/2019

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

  • Added: HCPCS codes needing a revised DIF when changes in calories prescribed

03/28/2019: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article and 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:

  • Clarified: Custom fit requirements

03/28/2019: 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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