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May 23, 2019

LCD and Policy Article Revisions Summary for May 23, 2019

Outlined below are the principal changes to the DME MAC Local Coverage Determination (LCD) and Policy Article (PA) that have been revised and posted. The policy included is Wheelchair Seating. Please review the entire LCD and related PA for complete information.

Wheelchair Seating

LCD

Wheelchair Seating 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

PA

Wheelchair Seating Policy ArticleExternal Website

Revision Effective Date: 01/01/2019

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

  • Removed: Statement to refer to diagnosis codes that support medical necessity section in the LCD
  • Added: Statement to refer to ICD-10 Codes that are Covered section in the LCD-related Policy Article

ICD-10 CODES THAT ARE COVERED:

  • Added: All diagnosis codes formerly listed in the LCD
  • Added: ICD-10 I69.342 to Group 3 due to clerical oversight
  • Added: ICD-10 codes M62.3, M62.89, Q67.8, Q68.1, and Q74.3 to Group 4 due to clerical oversight
  • Removed: References to Group 5

ICD-10 CODES THAT ARE NOT COVERED:

  • Added: Notation excluding all unlisted diagnosis codes from coverage for specified the HCPCS codes. Notation excluding all ICD-10 codes from coverage for E2610 and K0669.
  • Added: Notation (formerly referenced in the Group 5 Paragraph of the ICD-10 Codes that Support Medical Necessity section within the LCD) indicating that for HCPCS codes E0955, E2601, E2602, E2611, E2612 and E2619, diagnosis codes are not specified.

05/23/2019: 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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