March 19, 2020
LCD and Policy Article Revisions Summary for March 19, 2020
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 Wheelchair Options/Accessories. Please review the entire LCD and related PA for complete information.
Wheelchair Options/Accessories
LCD
Wheelchair Options/Accessories LCD
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
03/19/2020: 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
Wheelchair Options/Accessories PA
Revision Effective Date: 01/01/2020
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: Information related to GY modifier use, as a result of Final Rule 1713
CODING GUIDELINES:
- Revised: Format of HCPCS code references, from code 'spans' to individually-listed HCPCS
- Revised: Column II of table, to include E2398 for manual wheelchair bases and power wheelchair bases
03/19/2020: 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.