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April 4, 2019

LCD and Policy Article Revisions Summary for April 4, 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: Mechanical In-exsufflation Devices, Nebulizers, Oral Appliances for Obstructive Sleep Apnea, Oxygen and Oxygen Equipment, Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea, Power Mobility Devices, Respiratory Assist Devices, Standard Documentation Requirements for All Claims Submitted to DME MACs, Suction Pumps and Therapeutic Shoes for Persons with Diabetes. Please review the entire LCDs and related PAs for complete information.

Mechanical In-exsufflation Devices

PA

Mechanical In-exsufflation Devices Policy ArticleExternal Website

Revision Effective Date: 01/01/2019

CODING GUIDELINES:

  • Revised: E0467 Coding Guidelines to include custom fabricated oral appliances

04/04/2019: 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

PA

Nebulizers Policy ArticleExternal Website

Revision Effective Date: 01/01/2019

CODING GUIDELINES:

  • Revised: E0467 Coding Guidelines to include custom fabricated oral appliances

04/04/2019: 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 Appliances for Obstructive Sleep Apnea

LCD

Oral Appliances for Obstructive Sleep Apnea 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: 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

PA

Oral Appliances for Obstructive Sleep Apnea Policy ArticleExternal Website

Revision Effective Date: 01/01/2019

CODING GUIDELINES:

  • Added: E0467 Coding Guidelines
  • Revised: Language for custom fabricated oral appliance (E0486)

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

04/04/2019: 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

PA

Oxygen and Oxygen Equipment Policy ArticleExternal Website

Revision Effective Date: 01/01/2019

CODING GUIDELINES:

  • Revised: E0467 Coding Guidelines to include custom fabricated oral appliances
  • Added: E0447, E1405, and E1406 to HCPCS codes included in E0467

04/04/2019: 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.

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

PA

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

Revision Effective Date: 01/01/2019

CODING GUIDELINES:

  • Revised: E0467 Coding Guidelines to include custom fabricated oral appliances

04/04/2019: 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.

Power Mobility Devices

LCD

Power Mobility Devices LCDExternal Website

Revision Effective Date: 01/01/2019

PRESCRIPTION (ORDER) REQUIREMENTS:

  • Revised: PIM reference for 7-Element Orders from 5.9.2 to 5.2.4
  • Updated: 7-Element Order elements to be consistent with the PIM

PA

Power Mobility Devices Policy ArticleExternal Website

Revision Effective Date: 01/01/2019

POLICY SPECFIC DOCUMENTATION:

  • Removed: Prior Authorization of Power Mobility Devices (PMD) Demonstration information as program ended August 31, 2018.

CODING GUIDELINES:

  • Added: Coding guidelines for power wheelchair electronics

04/04/2019: 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.

Respiratory Assist Devices

PA

Respiratory Assist Devices Policy ArticleExternal Website

Revision Effective Date: 01/01/2019

CODING GUIDELINES:

  • Revised: E0467 Coding Guidelines to include custom fabricated oral appliances

04/04/2019: 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.

Standard Documentation Requirements for All Claims Submitted to DME MACs

PA

Standard Documentation Requirements for All Claims Submitted to DME MACs Policy ArticleExternal Website

Revision Effective Date: 01/01/2019

ARTICLE TEXT:

  • Removed: Last updated date

POWER MOBILITY DEVICES WOPD (7 ELEMENT ORDER):

  • Revised: 42 CFR 410.38(c) paragraph to remove the reference to HCPCS table

PROOF OF DELIVERY (POD):

  • Added: Postage paid delivery invoice option for POD documentation

04/04/2019: 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

PA

Suction Pumps Policy ArticleExternal Website

Revision Effective Date: 01/01/2019

CODING GUIDELINES:

  • Revised: E0467 Coding Guidelines to include custom fabricated oral appliances

04/04/2019: 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.

Therapeutic Shoes for Persons with Diabetes

LCD

Therapeutic Shoes for Persons with Diabetes LCDExternal Website

Revision Effective Date: 01/01/2019

HCPCS CODES

  • Removed: K0903 from Group 1 Codes, per annual HCPCS code release
  • Added: A5514 to Group 1 codes, crosswalk from K0903, per annual HCPCS code release
  • Revised: A5513 code narrative, per annual HCPCS code release

PA

Therapeutic Shoes for Persons with Diabetes Policy ArticleExternal Website

Revision Effective Date: 01/01/2019

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

  • Revised: References to K0903 crosswalked to A5514

CODING GUIDELINES:

  • Revised: References to K0903 crosswalked to A5514
  • Revised: RT and LT modifier billing instructions (Effective 03/01/2019)

04/04/2019: 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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