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June 11, 2020

LCD and Policy Article Revisions Summary for June 11, 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 Urological Supplies. Please review the entire LCD and related PA for complete information.

Urological Supplies

LCD

Urological Supplies LCDExternal Website

Revision Effective Date: 07/26/2020

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

  • Revised: Format of HCPCS code references, from code ‘spans’ to individually-listed
  • Added: Billing and coverage information for the inFlow device (HCPCS Code A4335)
  • Removed: Denial statement for inFlow device (A4335)

GENERAL:

  • Added: References to Standard Written Order (SWO)

REFILL REQUIREMENTS:

  • Revised: “ordering physicians” to “treating practitioners”

SUMMARY OF EVIDENCE:

  • Added: Information related to inFlow device

ANALYSIS OF EVIDENCE:

  • Added: Information related to inFlow device

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 “practitioner’s”

GENERAL DOCUMENTATION REQUIREMENTS:

  • Revised: “Prescriptions (orders)” to “SWO”

BIBLIOGRAPHY:

  • Added: Section related to inFlow device

RELATED LOCAL COVERAGE DOCUMENTS:

  • Added: Response to Comments (A58231)

PA

Urological Supplies PAExternal Website

Revision Effective Date: 07/26/2020

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

GENERAL:

  • Revised: Billing direction for inFlow and urological supplies when inserted or used in a practitioner’s office
  • Revised: “physician” updated to “treating practitioner”

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

  • Added: Directional statement regarding practitioner as supplier
  • Added: Continued medical need language

MODIFIER:

  • Added: inFlow device to KX modifier directions

MISCELLANEOUS:

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

CODING GUIDELINES:

  • Revised: Format of HCPCS code references, from code ‘spans’ to individually-listed
  • Revised: inFlow device statement to replace battery and/or wand with “activator”

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”

06/11/2020: 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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