Skip to main content
Corporate
CGS Administrators, LLC

IVR: 866.238.9650 Customer Service and myCGS: 866.270.4909

March 5, 2020

LCD and Policy Article Revisions Summary for March 5, 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: Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea, Spinal Orthoses: TLSO and LSO, Surgical Dressings, and Therapeutic Shoes for Persons with Diabetes. Please review the entire LCDs and related PAs for complete information.

Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea

LCD

Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea LCDExternal Website

Revision Effective Date: 01/01/2020

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

  • Revised: "face-to-face" to "in-person" where applicable
  • Revised: "practitioner" to "treating practitioner"
  • Revised: Order information as a result of Final Rule 1713

REFILL REQUIREMENTS:

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

GENERAL DOCUMENTATION REQUIREMENTS:

  • Revised: Prescriptions (orders) to SWO

03/05/2020: 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

Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea 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

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

  • Added: "in-person" to initial evaluation
  • Revised: "practitioner" to "treating practitioner"
  • Removed: Dispensing order and WOPD related information

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"

03/05/2020: 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.

Spinal Orthoses: TLSO and LSO

LCD

Spinal Orthoses: TLSO and LSO 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

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

03/05/2020: 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

Spinal Orthoses: TLSO and LSO 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" to "treating practitioner"
  • Revised: "prescribing practitioner" to "treating practitioner"

CODING GUIDELINES:

  • Revised: Format of HCPCS code references, from code 'spans' to individually-listed HCPCS
  • Revised: HCPCS codes referenced for body jacket type orthoses, to include L0651
  • Revised: HCPCS codes referenced for billing of prefabricated orthoses, to include L0640, L0641, L0642, L0643, L0648, L0649, L0650, and L0651

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"

03/05/2020: 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.

Surgical Dressings

PA

Surgical Dressings PAExternal Website

Revision Effective Date: 01/01/2020

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

  • Revised: Initial wound evaluation record specifications
  • Clarified: Direction on need for weekly evaluations
  • Added: Statement that the person doing the evaluation may have no financial relation with the supplier
  • Clarified: Ongoing evaluations as "weekly or monthly"

03/05/2020: 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.

Therapeutic Shoes for Persons with Diabetes

LCD

Therapeutic Shoes for Persons with Diabetes 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"

03/05/2020: 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

Therapeutic Shoes for Persons with Diabetes PAExternal Website

Revision Effective Date: 01/01/2020

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

  • Revised: Order information as a result of 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

CODING GUIDELINES:

  • Revised: Format of HCPCS code references, from code 'spans' to individually-listed HCPCS
  • Revised: HCPCS codes referenced for inserts and modifications, to include A5514

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"

03/05/2020: 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.

26 Century Blvd Ste ST610, Nashville, TN 37214-3685 © CGS Administrators, LLC. All Rights Reserved