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February 27, 2020

LCD and Policy Article Revisions Summary for February 27, 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: Knee Orthoses, Pressure Reducing Support Surfaces – Group 1, Pressure Reducing Support Surfaces – Group 2, Pressure Reducing Support Surfaces – Group 3, Respiratory Assist Devices, Seat Lift Mechanisms, Speech Generating Devices (SGD), Tracheostomy Care Supplies, Transcutaneous Electrical Joint Stimulation Devices (TEJSD), Transcutaneous Electrical Nerve Stimulators (TENS), and Tumor Treatment Field Therapy (TTFT). Please review the entire LCDs and related PAs for complete information.

Knee Orthoses

LCD

Knee Orthoses LCDExternal PDF

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

02/27/2020: 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

Knee Orthoses PAExternal PDF

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

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: L1845, L1846 and L1852 rotation control to include "and posterior"

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"

02/27/2020: 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.

Pressure Reducing Support Surfaces – Group 1

LCD

Pressure Reducing Support Surfaces – Group 1 LCDExternal PDF

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

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"

GENERAL DOCUMENTATION REQUIREMENTS:

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

02/27/2020: 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

Pressure Reducing Support Surfaces – Group 1 PAExternal PDF

Revision Effective Date: 01/01/2020

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

  • Remove: 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

RELATED CLINICAL INFORMATION:

  • Revised: "physician" to "treating practitioner"

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"

02/27/2020: 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.

Pressure Reducing Support Surfaces – Group 2

LCD

Pressure Reducing Support Surfaces – Group 2 LCDExternal PDF

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
  • Revised: "physician" to "treating practitioner"

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"

GENERAL DOCUMENTATION REQUIREMENTS:

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

02/27/2020: 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

Pressure Reducing Support Surfaces – Group 2 PAExternal PDF

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

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"

02/27/2020: 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.

Pressure Reducing Support Surfaces – Group 3

LCD

Pressure Reducing Support Surfaces – Group 3 LCDExternal PDF

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

02/27/2020: 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

Pressure Reducing Support Surfaces – Group 3 PAExternal PDF

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

MODIFIERS:

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

MISCELLANEOUS:

  • Revised: "physician" to "practitioner"

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"

02/27/2020: 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.

Respiratory Assist Devices

LCD

Respiratory Assist Devices LCDExternal PDF

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

  • Revised: "physician" to "practitioner"

GENERAL:

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

REFILL REQUIREMENTS:

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

REPLACEMENT:

  • Revised: "physician" to "treating practitioner"

BENEFICIARIES ENTERING MEDICARE:

  • Revised: "physician" to "treating practitioner"

SLEEP TESTS:

  • Revised: "physician" to "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"

DOCUMENTATION REQUIREMENTS:

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

GENERAL DOCUMENTATION REQUIREMENTS:

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

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

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

02/27/20: 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

Respiratory Assist Devices PAExternal PDF

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

MODIFIERS:

  • Revised: "physician" to "practitioner"

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"

02/27/2020: 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.

Seat Lift Mechanisms

LCD

Seat Lift Mechanisms LCDExternal PDF

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

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

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"

02/27/2020: 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

Seat Lift Mechanisms PAExternal PDF

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

CERTIFICATE OF MEDICAL NECESSITY (CMN):

  • Revised: "physician" to "treating practitioner"
  • Removed: CMN form version number "(DME form 07.03A)"
  • Revised: "detailed written order" to "Standard Written Order (SWO)"

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"

02/27/2020: 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.

Speech Generating Devices (SGD)

LCD

Speech Generating Devices (SGD) LCDExternal PDF

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: "physician" to "practitioner"
  • 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

02/27/2020: 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

Speech Generating Devices (SGD) PAExternal PDF

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

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

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

MODIFIERS:

  • 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"

02/27/2020: 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.

Tracheostomy Care Supplies

LCD

Tracheostomy Care Supplies LCDExternal PDF

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"

02/27/2020: 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

Tracheostomy Care Supplies PAExternal PDF

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

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"

02/27/2020: 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.

Transcutaneous Electrical Joint Stimulation Devices (TEJSD)

LCD

Transcutaneous Electrical Joint Stimulation Devices (TEJSD) LCDExternal PDF

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"

02/27/2020: 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

Transcutaneous Electrical Joint Stimulation Devices (TEJSD) PAExternal PDF

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

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"

02/27/2020: 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.

Transcutaneous Electrical Nerve Stimulators (TENS)

LCD

Transcutaneous Electrical Nerve Stimulators (TENS) LCDExternal PDF

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

  • Revised: "physician" to "practitioner"
  • 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"

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"

02/27/2020: 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

Transcutaneous Electrical Nerve Stimulators (TENS) PAExternal PDF

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

CERTIFICATE OF MEDICAL NECESSITY (CMN):

  • Revised: "physician" to "practitioner"
  • Revised: "physician" to "treating practitioner"
  • Removed: CMN form version number "(DME form 06.03B)"
  • Revised: "detailed written order" to "Standard Written Order (SWO)"
  • Revised: "detailed written order" to "SWO"

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"

02/27/2020: 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.

TumorTreatment Field Therapy (TTFT)

LCD

Tumor Treatment Field Therapy (TTFT) LCDExternal PDF

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

  • Revised: "face-to-face" to "in-person", where applicable
  • 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

02/27/2020: 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

Tumor Treatment Field Therapy (TTFT) PAExternal PDF

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

MISCELLANEOUS:

  • Removed: EY modifier language which is now incorporated in the SDR

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"

02/27/2020: 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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