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July 18, 2019

LCD and Policy Article Revisions Summary for July 18, 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 Tumor Treatment Field Therapy (TTFT). Please review the entire LCD and related PA for complete information.

Tumor Treatment Field Therapy (TTFT)

LCD

Tumor Treatment Field Therapy (TTFT) LCDExternal website

Revision Effective Date: 09/01/2019

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

  • Added: Criteria for Initial Coverage for Newly Diagnosed Glioblastoma Multiforme
  • Added: Criteria for Continued Coverage for Newly Diagnosed GBM Beyond the First Three Months of Therapy
  • Added: Coverage statement for Recurrent GBM
  • Added: Coverage statement for Other Uses
  • Added: Beneficiaries Entering Medicare FFS requirements

SUMMARY OF EVIDENCE:

  • Added: Summary of evidence reviewed

ANALYSIS OF EVIDENCE (RATIONALE FOR DETERMINATION):

  • Added: Background, CAC and key question information, and Conclusion

HCPCS CODES:

  • Added: HCPCS Modifiers GA, GZ, KF, and KX

SOURCES OF INFORMATION:

  • Added: References to sources of information

BIBLIOGRAPHY:

  • Added: Bibliography information

RELATED LOCAL COVERAGE DOCUMENTS:

  • Added: Response to Comments: Tumor Treatment Field Therapy (TTFT) – DL34823

Policy Article

Tumor Treatment Field Therapy (TTFT) Policy ArticleExternal website

Revision Effective Date: 09/01/2019

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

  • Added: Documentation requirements for Initial Coverage (First Three Months)
  • Added: Documentation requirements for Continued Coverage Beyond the First Three Months of Therapy
  • Added: Documentation required for Equipment Retained From a Prior Payer
  • Added: Proof of Delivery Requirements for Recently Eligible Medicare FFS Beneficiaries
  • Added: GA, GZ, KF and KX modifier usage information
  • Added: Miscellaneous information

07/18/2019: 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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