April 16, 2020
LCD and Policy Article Revisions Summary for April 16, 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 External Infusion Pumps. Please review the entire LCD and related PA for complete information.
External Infusion Pumps
LCD
Revision Effective Date: 05/31/2020
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
- Added: Statement regarding base and related accessories and supplies (BPM Ch. 15, Section 110.3)
- Revised: "physician" to "practitioner"
- Added: Xembify® to coverage criteria V(H)
- Added: Statement regarding covered pumps for Xembify®
- Revised: "physicians" to "practitioners"
GENERAL:
- 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 Xembify®
ANALYSIS OF EVIDENCE:
- Added: Information related to Xembify®
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
BIBLIOGRAPHY:
- Added: Section related to Xembify®
RELATED LOCAL COVERAGE DOCUMENTS:
- Added: Response to Comments document
PA
Revision Effective Date: 05/31/2020
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
- Revised: "physician's" to "practitioner's"
- 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
DME INFORMATION FORM (DIF):
- Revised: "physician" to "practitioner"
MODIFIERS:
- Added: J7799 (Xembify®) to the JB modifier requirements
CODING GUIDELINES:
- Revised: 'detailed order' to 'standard written order'
- Added: UOS billing instruction for J7799 (Xembify®)
ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:
- Added: J7799 (Xembify®) to the Group 3 paragraph
04/16/2020: 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.