License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

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POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

End User License Agreement

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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.