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April 2, 2020

LCD and Policy Article Revisions Summary for April 2, 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 Nebulizers and Standard Documentation Requirements for All Claims Submitted to DME MACs. Please review the entire LCD and related PAs for complete information.

Nebulizers

LCD

Nebulizers LCDExternal Website

Revision Effective Date: 05/17/2020

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

  • Added: Statement regarding base and related accessories and supplies (BPM Ch. 15, Section 110.3)
  • Clarified: “considered for coverage” to drug and equipment criteria
  • Added: Revefenacin to inhalation solutions for the management of obstructive pulmonary disease - For Dates of Service on or after 11/9/2018 (FDA Approval Date)
  • Revised: “alpha” to “alfa” in relation to HCPCS code J7639
  • 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: “alpha” to “alfa” in table with maximum milligrams/month
  • Added: Revefenacin to table with maximum milligrams/month
  • Added: Information regarding concurrent use of long-acting and short-acting muscarinic antagonists
  • Revised: Format of HCPCS code references, from code ‘spans’ to individually-listed HCPCS codes
  • Revised: "physician" to "practitioner"
  • Revised: Order information as a result of Final Rule 1713

REFILL REQUIREMENTS:

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

SUMMARY OF EVIDENCE:

  • Added: Information related to revefenacin

ANALYSIS OF EVIDENCE:

  • Added: Information related to revefenacin

HCPCS CODES:

  • Added: J7677 to Group 3 Codes in the HCPCS code table

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

BIBLIOGRAPHY:

  • Added: Section related to revefenacin

RELATED LOCAL COVERAGE DOCUMENTS:

  • Added: Response to Comments (A58035)

PA

Nebulizers PAExternal Website

Revision Effective Date: 05/17/2020

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

  • Removed: STATUTORY PRESCRIPTION (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

CODING GUIDELINES:

  • Revised: “alpha” to “alfa” in relation to HCPCS code J7639
  • Added: Coding guidelines for J7677

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”
  • Added: HCPCS code J7677 to Group 8 Paragraph
  • Revised: ICD-10 code descriptor for J44.0, per ICD-10 code update

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”

04/02/2020: 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.

Standard Documentation Requirements for All Claims Submitted to DME MACs

PA

Standard Documentation Requirements for All Claims Submitted to DME MACs PAExternal Website

Revision Effective Date: 04/06/2020

REFILL DOCUMENTATION:

  • Added: "REQUIREMENTS" to title

PROOF OF DELIVERY (POD):

  • Added: Prohibition for billing prior to discharge date

04/02/2020: 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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