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December 19, 2019

LCD and Policy Article Revisions Summary for December 19, 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 Ankle-Foot/Knee-Ankle-Foot Orthosis, External Infusion Pumps, Parenteral Nutrition and Wheelchair Options/Accessories. 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: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

  • Removed: Statement to refer to ICD-10 Codes that are Covered section in the LCD-related PA
  • Added: Statement to refer to ICD-10 code list in the LCD-related Policy Article

HCPCS CODES:

  • Added: HCPCS L2006 to Group 1 codes, per annual HCPCS code release

Policy Article

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

Revision Effective Date: 01/01/2020

CODING GUIDELINES:

  • Added: L2006 Coding Guideline

ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:

  • Revised: Section header "ICD-10 Codes that are Covered" updated to "ICD-10 Codes that Support Medical Necessity"

ICD-10 CODES THAT DO NOT SUPPORT MEDICAL NECESSITY:

  • Revised: Section header "ICD-10 Codes that are Not Covered" updated to "ICD-10 Codes that DO NOT Support Medical Necessity"

12/19/2019: 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.

External Infusion Pumps

LCD

External Infusion Pumps LCDExternal website

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

  • Added: Coverage information for E0787

Removed: Statement to refer to ICD-10 Codes that are Covered section in the LCD-related PA

  • Added: Statement to refer to ICD-10 code list in the LCD-related Policy Article
  • Added: E0787 to IV pole paragraph

HCPCS CODES:

  • Added: E0787 to Group 1 and A4226 to Group 2

Policy Article

External Infusion Pumps Policy ArticleExternal website

Revision Effective Date: 01/01/2020

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES

  • Added: PDAC approval requirement for HCPCS code E0787

KX, GA, GY and GZ MODIFIERS:

  • Added: HCPCS code E0787

CODING GUIDELINES:

  • Added: Coding information for E0787 and A4226
  • Added: All-inclusive statement to A4224

ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:

  • Revised: Section header "ICD-10 Codes that are Covered" updated to "ICD-10 Codes that Support Medical Necessity"
  • Added: E0787 to Group 1

ICD-10 CODES THAT DO NOT SUPPORT MEDICAL NECESSITY:

  • Revised: Section header "ICD-10 Codes that are Not Covered" updated to "ICD-10 Codes that DO NOT Support Medical Necessity"

12/19/2019: 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

LCD

Parenteral Nutrition LCDExternal website

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

  • Added: B4187 to NUTRIENTS section

HCPCS CODES:

  • Revised: Code narrative for B4185
  • Added: B4187 to Group 1

Policy Article

Parenteral Nutrition Policy ArticleExternal website

Revision Effective Date: 01/01/2020

CODING GUIDELINES:

  • Added: B4187 to guidance

ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:

  • Revised: Section header "ICD-10 Codes that are Covered" updated to "ICD-10 Codes that Support Medical Necessity"

ICD-10 CODES THAT DO NOT SUPPORT MEDICAL NECESSITY:

  • Revised: Section header "ICD-10 Codes that are Not Covered" updated to "ICD-10 Codes that DO NOT Support Medical Necessity"

12/19/2019: 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.

Wheelchair Options/Accessories

LCD

Wheelchair Options/Accessories LCDExternal website

Revision Effective Date: 01/01/2020

HCPCS CODES:

  • Added: HCPCS E2398 to Group 9 codes, per annual HCPCS code release

Policy Article

Wheelchair Options/Accessories Policy ArticleExternal website

Revision Effective Date: 01/01/2020

CODING GUIDELINES:

  • Added: E2398 Coding Guideline

ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:

  • Revised: Section header "ICD-10 Codes that are Covered" updated to "ICD-10 Codes that Support Medical Necessity"
  • Added: Group 1 ICD-10 codes G80.0, G80.1, G80.2, G80.3, G80.4, G80.8, G80.9, G93.1, S06.2X0S, S06.2X1S, S06.2X2S, S06.2X3S, S06.2X4S, S06.2X5S, S06.2X6S, S06.2X9S

ICD-10 CODES THAT DO NOT SUPPORT MEDICAL NECESSITY:

  • Revised: Section header "ICD-10 Codes that are Not Covered" updated to "ICD-10 Codes that DO NOT Support Medical Necessity"

12/19/2019: 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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