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February 20, 2020

LCD and Policy Article Revisions Summary for February 20, 2020

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, Eye Prostheses, Facial Prostheses, Glucose Monitors, Manual Wheelchair Bases, Orthopedic Footwear, Ostomy Supplies, Parenteral Nutrition, Patient Lifts, Pneumatic Compression Devices, Suction Pumps and Walkers. 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:

  • Revised: Format of HCPCS code references, from code 'spans' to individually-listed HCPCS
  • Revised: Order information as a result of Final Rule 1713

HCPCS CODES:

  • Revised: HCPCS L2006 code description per quarterly HCPCS code update

CODING INFORMATION:

  • Removed: Field titled "Bill Type"
  • Removed: Field titled "Revenue Codes"
  • Removed: Field titled "ICD-10 Codes that Support Medical Necessity"
  • Removed: Field titled "ICD-10 Codes that DO NOT Support Medical Necessity"
  • Removed: Field titled "Additional ICD-10 Information"

DOCUMENTATION REQUIREMENTS:

  • Revised: "physician's" to "treating practitioner's"

GENERAL DOCUMENTATION REQUIREMENTS:

  • Revised: Prescriptions (orders) to SWO

02/20/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713, HCPCS code changes, and non-substantive corrections (listing individual HCPCS codes instead of a HCPCS code-span). During the exercise of listing individual HCPCS codes, L2006 had been inadvertently added because it fell within a code span and is being deleted.

PA

Ankle-Foot/Knee-Ankle-Foot Orthosis PAExternal Website

Revision Effective Date: 01/01/2020

REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 Fed. Reg Vol 217):

  • Added: Section and related information based on Final Rule 1713

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

  • Revised: "ordering physician's" to "treating practitioner's"
  • Revised: "physician's" to "practitioner's"
  • Revised: Format of HCPCS code references, from code 'spans' to individually-listed HCPCS

CODING GUIDELINES:

  • Revised: Format of HCPCS code references, from code 'spans' to individually-listed HCPCS
  • Added: Coding Guidelines for L1900, L1902, L1904, L1907, L1910, L1920, L1930, L1932, L1940, L1945, L1950, L1951, L1970, L1971, L1980, and L1990
  • Revised: L1906 Coding Guideline
  • Revised: L2006 Coding Guideline per quarterly HCPCS code update
  • Removed: HCPCS K0903
  • Added: HCPCS A5514, crosswalk from K0903
  • Removed: Reference of effective DOS for K0903
  • Added: Reference of effective DOS for A5514

02/20/2020: 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.

Eye Prostheses

LCD

Eye Prostheses LCDExternal Website

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

  • Revised: Order information as a result of Final Rule 1713

CODING INFORMATION:

  • Removed: Field titled "Bill Type"
  • Removed: Field titled "Revenue Codes"
  • Removed: Field titled "ICD-10 Codes that Support Medical Necessity"
  • Removed: Field titled "ICD-10 Codes that DO NOT Support Medical Necessity"
  • Removed: Field titled "Additional ICD-10 Information"

GENERAL DOCUMENTATION REQUIREMENTS:

  • Revised: Prescriptions (orders) to SWO

02/20/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713.

PA

Eye Prostheses PAExternal Website

Revision Effective Date: 01/01/2020

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

  • Revised: "physician's" to "treating practitioner's"

REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 Fed. Reg Vol 217):

  • Added: Section and related information based on Final Rule 1713

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

  • Revised: "physician's" to "treating practitioner's"

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"

02/20/2020: 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.

Facial Prostheses

LCD

Facial Prostheses LCDExternal Website

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

  • Revised: Order information as a result of Final Rule 1713

CODING INFORMATION:

  • Removed: Field titled "Bill Type"
  • Removed: Field titled "Revenue Codes"
  • Removed: Field titled "ICD-10 Codes that Support Medical Necessity"
  • Removed: Field titled "ICD-10 Codes that DO NOT Support Medical Necessity"
  • Removed: Field titled "Additional ICD-10 Information"

GENERAL DOCUMENTATION REQUIREMENTS:

  • Revised: Prescriptions (orders) to SWO

02/20/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713.

PA

Facial Prostheses PAExternal Website

Revision Effective Date: 01/01/2020

REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 Fed. Reg Vol 217):

  • Added: Section and related information based on Final Rule 1713

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

  • Revised: "physician's" to "treating practitioner's"

CODING GUIDELINES:

  • Revised: Format of HCPCS code references, from code spans to individually-listed HCPCS

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"

02/20/2020: 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.

Glucose Monitors

LCD

Glucose Monitors 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
  • Revised: "physician" to "treating practitioner"
  • Revised: "treating physician" to "treating practitioner"
  • Revised: "month" to "30 days," as clarification of billing K0553
  • Revised: Format of HCPCS code references, from code spans to individually-listed HCPCS
  • Revised: Order information as a result of Final Rule 1713

REFILL REQUIREMENTS:

  • Revised: "ordering physician" to "treating practitioner"

CODING INFORMATION:

  • Removed: Field titled "Bill Type"
  • Removed: Field titled "Revenue Codes"
  • Removed: Field titled "ICD-10 Codes that Support Medical Necessity"
  • Removed: Field titled "ICD-10 Codes that DO NOT Support Medical Necessity"
  • Removed: Field titled "Additional ICD-10 Information"

GENERAL DOCUMENTATION REQUIREMENTS:

  • Revised: Prescriptions (orders) to SWO

APPENDICES:

  • Revised: "physician" to "practitioner"

02/20/2020: Pursuant to the 21st Century Cures Act , these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713, HCPCS code changes, and non-substantive corrections (listing individual HCPCS codes instead of a HCPCS code-span).

PA

Glucose Monitors PAExternal Website

Revision Effective Date: 01/01/2020

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

  • Removed: STATUTORY ORDER REQUIRMENTS section
  • Removed: REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO 42 CFR 410.38(g) section

REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 Fed. Reg Vol 217):

  • Added: Section and related information based on Final Rule 1713

MODIFIERS:

  • Revised: Format of HCPCS code references, from code spans to individually-listed HCPCS

CODING GUIDELINES:

  • Clarified: Coding guideline related to K0553 billing timeline
  • Revised: Format of HCPCS code references, from code spans to individually-listed HCPCS

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"

02/20/2020: 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.

Manual Wheelchair Bases

LCD

Manual Wheelchair Bases LCDExternal Website

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

  • Revised: Format of HCPCS codes, from 'code spans' to individually-listed HCPCS
  • Revised: Order information as a result of Final Rule 1713

CODING INFORMATION:

  • Removed: Field titled "Bill Type"
  • Removed: Field titled "Revenue Codes"
  • Removed: Field titled "ICD-10 Codes that Support Medical Necessity"
  • Removed: Field titled "ICD-10 Codes that DO NOT Support Medical Necessity"
  • Removed: Field titled "Additional ICD-10 Information"

DOCUMENTATION REQUIREMENTS:

  • Revised: "physician's" to "treating practitioner's"

GENERAL DOCUENTATION REQUIREMENTS:

  • Revised: Prescriptions (orders) to SWO

02/20/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713, HCPCS code changes, and non-substantive corrections (listing individual HCPCS codes instead of a HCPCS code-span).

PA

Manual Wheelchair Bases PAExternal Website

Revision Effective Date: 01/01/2020

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

  • Revised: "physician" to "practitioner"

REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO 42 CFR 410.38(g):

  • Removed: Section due to Final Rule 1713

REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 Fed. Reg Vol 217):

  • Added: Section and related information based on Final Rule 1713

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

  • Revised: Format of HCPCS code references, from code 'spans' to individually-listed HCPCS

CODING GUIDELINES:

  • Revised: Format of HCPCS code references, from code 'spans' to individually-listed HCPCS

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"

02/20/2020: 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.

Orthopedic Footwear

LCD

Orthopedic Footwear LCDExternal Website

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

  • Revised: Statement to refer to ICD-10 code list in the LCD-related Policy Article

GENERAL:

  • Revised: Order information as a result of Final Rule 1713

CODING INFORMATION:

  • Removed: Field titled "Bill Type"
  • Removed: Field titled "Revenue Codes"
  • Removed: Field titled "ICD-10 Codes that Support Medical Necessity"
  • Removed: Field titled "ICD-10 Codes that DO NOT Support Medical Necessity"
  • Removed: Field titled "Additional ICD-10 Information"

DOCUMENTATION REQUIREMENTS:

  • Revised: "physician's" to "treating practitioner's"

GENERAL DOCUMENTATION REQUIREMENTS:

  • Revised: "Prescriptions (orders)" to "SWO"

02/20/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713.

PA

Orthopedic Footwear PAExternal Website

Revision Effective Date: 01/01/2020

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

  • Revised: Format of HCPCS code references, from code spans to individually-listed HCPCS
  • Removed: Therapeutic Shoes for Persons with Diabetes codes, leaving reference to the policy

REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 Fed. Reg Vol 217):

  • Added: Section and related information based on Final Rule 1713

CODING GUIDELINES:

  • Revised: Format of HCPCS code references, from code spans to individually-listed HCPCS
  • Removed: Therapeutic Shoes for Persons with Diabetes codes, leaving reference to the policy

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"

02/20/2020: 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.

Ostomy Supplies

LCD

Ostomy Supplies LCDExternal Website

Revision Effective Date: 01/01/2020

GENERAL:

  • Revised: Order information as a result of Final Rule 1713

REFILL REQUIREMENTS:

  • Revised: "ordering physicians" to "treating practitioners"

CODING INFORMATION:

  • Removed: Field titled "Bill Type"
  • Removed: Field titled "Revenue Codes"
  • Removed: Field titled "ICD-10 Codes that Support Medical Necessity"
  • Removed: Field titled "ICD-10 Codes that DO NOT Support Medical Necessity"
  • Removed: Field titled "Additional ICD-10 Information"

DOCUMENTATION REQUIREMENTS:

  • Revised: "physician's" to "treating practitioner's"

GENERAL DOCUMENTATION REQUIREMENTS:

  • Revised: "Prescriptions (orders)" to "SWO"

02/20/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713.

PA

Ostomy Supplies PAExternal Website

Revision Effective Date: 01/01/2020

REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 Fed. Reg Vol 217):

  • Added: Section and related information based on Final Rule 1713

CODING GUIDELINES:

  • Revised: Format of HCPCS code references, from code spans to individually-listed HCPCS

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"

02/20/2020: 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:

  • Revised: "ordering physician" to "treating practitioner"

NUTRIENTS:

  • Revised: "ordering physician" to "treating practitioner"
  • Revised: Format of HCPCS codes, from 'code spans' to individually-listed HCPCS

EQUIPMENT AND SUPPLIES:

  • Revised: Format of HCPCS code references, from 'code spans' to individually-listed HCPCS

GENERAL:

  • Revised: Order information as a result of Final Rule 1713

REFILL REQUIREMENTS:

  • Revised: "ordering physicians" to "treating practitioners"

CODING INFORMATION:

  • Removed: Field titled "Bill Type"
  • Removed: Field titled "Revenue Codes"
  • Removed: Field titled "ICD-10 Codes that Support Medical Necessity"
  • Removed: Field titled "ICD-10 Codes that DO NOT Support Medical Necessity"
  • Removed: Field titled "Additional ICD-10 Information"

DOCUMENTATION REQUIREMENTS:

  • Revised: "physician's" to "treating practitioner's"

GENERAL DOCUMENTATION REQUIREMENTS:

  • Revised: "Prescriptions (orders)" to "SWO"

02/20/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713, HCPCS code changes, and non-substantive corrections (listing individual HCPCS codes instead of a HCPCS code-span).

PA

Parenteral Nutrition PAExternal Website

Revision Effective Date: 01/01/2020

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

  • Revised: "attending physician" to "treating practitioner"

REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 Fed. Reg Vol 217):

  • Added: Section and related information based on Final Rule 1713

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

  • Revised: "physician" to "treating practitioner"
  • Revised: Format of HCPCS code references, from 'code spans' to individually-listed HCPCS

DME INFORMATION FORM (DIF):

  • Revised: "ordering physician" to "treating practitioner"
  • Revised: Format of HCPCS code references, from 'code spans' to individually-listed HCPCS

CODING GUIDELINES:

  • Revised: Format of HCPCS code references, from 'code spans' to individually-listed HCPCS

02/20/2020: 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.

Patient Lifts

LCD

Patient Lifts LCDExternal Website

Revision Effective Date: 01/01/2020

GENERAL:

  • Revised: Order information as a result of Final Rule 1713

CODING INFORMATION:

  • Removed: Field titled "Bill Type"
  • Removed: Field titled "Revenue Codes"
  • Removed: Field titled "ICD-10 Codes that Support Medical Necessity"
  • Removed: Field titled "ICD-10 Codes that DO NOT Support Medical Necessity"
  • Removed: Field titled "Additional ICD-10 Information"

DOCUMENTATION REQUIREMENTS:

  • Revised: "physician's" to "treating practitioner's"

GENERAL DOCUMENTATION REQUIREMENTS:

  • Revised: "Prescriptions (orders)" to "SWO"

02/20/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713.

PA

Patient Lifts PAExternal Website

Revision Effective Date: 01/01/2020

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

  • Removed: REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO 42 CFR 410.38(g) section

REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 Fed. Reg Vol 217):

  • Added: Section and related information based on Final Rule 1713

CODING GUIDELINES:

  • Revised: Format of HCPCS code references, from 'code spans' to individually-listed HCPCS

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"

02/20/2020: 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.

Pneumatic Compression Devices

LCD

Pneumatic Compression Devices LCDExternal Website

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

  • Revised: "prescribing physician" to "treating practitioner"
  • Revised: "physician" to "practitioner"
  • Revised: Format of HCPCS code references, from code spans to individually-listed HCPCS

GENERAL:

  • Revised: Order information as a result of Final Rule 1713

CODING INFORMATION:

  • Removed: Field titled "Bill Type"
  • Removed: Field titled "Revenue Codes"
  • Removed: Field titled "ICD-10 Codes that Support Medical Necessity"
  • Removed: Field titled "ICD-10 Codes that DO NOT Support Medical Necessity"
  • Removed: Field titled "Additional ICD-10 Information"

DOCUMENTATION REQUIREMENTS:

  • Revised: "physician's" to "treating practitioner's"

GENERAL DOCUMENTATION REQUIREMENTS:

  • Revised: "Prescriptions (orders)" to "SWO"

02/20/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713, HCPCS code changes, and non-substantive corrections (listing individual HCPCS codes instead of a HCPCS code-span).

PA

Pneumatic Compression Devices PAExternal Website

Revision Effective Date: 01/01/2020

REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO 42 CFR 410.38(g):

  • Removed: Entire section based on Final Rule 1713

REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 Fed. Reg Vol 217):

  • Added: Section and related information based on Final Rule 1713

CERTIFICATE OF MEDICAL NECESSITY (CMN):

  • Revised: Section header to remove PIM reference
  • Revised: "physician" to "treating practitioner"
  • Revised: Detailed Written Order to SWO
  • Removed: CMN DME form version number

CODING GUIDELINES:

  • Revised: Format of HCPCS code references, from code spans to individually-listed HCPCS

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"

02/20/2020: 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

LCD

Suction Pumps 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

GENERAL:

  • Revised: Order information as a result of Final Rule 1713

REFILL REQUIREMENTS:

  • Revised: "ordering physicians" to "treating practitioners"

CODING INFORMATION:

  • Removed: Field titled "Bill Type"
  • Removed: Field titled "Revenue Codes"
  • Removed: Field titled "ICD-10 Codes that Support Medical Necessity"
  • Removed: Field titled "ICD-10 Codes that DO NOT Support Medical Necessity"
  • Removed: Field titled "Additional ICD-10 Information"

DOCUMENTATION REQUIREMENTS:

  • Revised: "physician's" to "treating practitioner's"

GENERAL DOCUMENTATION REQUIREMENTS:

  • Revised: "Prescriptions (orders)" to "SWO"

02/20/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713.

PA

Suction Pumps PAExternal Website

Revision Effective Date: 01/01/2020

REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 Fed. Reg Vol 217):

  • Added: Section and related information based on Final Rule 1713

CODING GUIDELINES:

  • Revised: Format of HCPCS code references, from 'code spans' to individually-listed HCPCS

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"

02/20/2020: 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.

Walkers

LCD

Walkers LCDExternal Website

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

  • Revised: Order information as a result of Final Rule 1713

CODING INFORMATION:

  • Removed: Field titled "Bill Type"
  • Removed: Field titled "Revenue Codes"
  • Removed: Field titled "ICD-10 Codes that Support Medical Necessity"
  • Removed: Field titled "ICD-10 Codes that DO NOT Support Medical Necessity"
  • Removed: Field titled "Additional ICD-10 Information"

DOCUMENTATION REQUIREMENTS:

  • Revised: "physician's" to "treating practitioner's"

GENERAL DOCUENTATION REQUIREMENTS:

  • Revised: Prescriptions (orders) to SWO

02/20/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713.

PA

Walkers PAExternal Website

Revision Effective Date: 01/01/2020

REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 Fed. Reg Vol 217):

  • Added: Section and related information based on Final Rule 1713

CODING GUIDELINES:

  • Revised: Format of HCPCS code references, from code 'spans' to individually-listed HCPCS

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"

02/20/2020: 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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