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March 11, 2021

Policy Article Revisions Summary for March 11, 2021

Outlined below are the principal changes to the DME MAC Policy Articles (PAs) that have been revised and posted. The policies included are Ankle-Foot/Knee-Ankle-Foot Orthoses, Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics), Orthopedic Footwear, Osteogenesis Stimulators, Speech Generating Devices (SGD), Spinal Orthoses: TLSO and LSO, Standard Documentation Requirements for All Claims Submitted to DME MACs and Vacuum Erection Devices (VED). Please review the entire LCDs and related PAs for complete information.

Ankle-Foot/Knee-Ankle-Foot Orthoses

PA

Ankle-Foot/Knee-Ankle-Foot Orthoses PAExternal Website

Revision Effective Date: 02/01/2021

CODING GUIDELINES:

  • Removed: Coding verification review information for HCPCS codes L1906 and L2006

CODING VERIFICATION REVIEW:

  • Added: Section header and PDAC coding verification review information
  • Added: Coding verification review information for HCPCS codes L1906 and L2006

03/11/2021: 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.

Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics)

PA

Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) PAExternal Website

Revision Effective Date: 01/01/2020

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

  • Removed: HCPCS Codes Q0981 and Q9978 which are no longer valid for billing

CODING GUIDELINES:

  • Removed: HCPCS Codes Q9978 and Q9981 which are no longer valid for billing

03/11/2021: 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.

Orthopedic Footwear

PA

Orthopedic Footwear PAExternal Website

Revision Effective Date: 01/01/2020

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

  • Added: HCPCS code L3000 to noncovered statement, previously omitted in error

03/11/2021: 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.

Osteogenesis Stimulators

PA

Osteogenesis Stimulators PAExternal Website

Revision Effective Date: 01/01/2020

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

  • Added: Class III devices and KF modifier requirement for HCPCS codes E0747, E0748 and E0760

CODING GUIDELINES:

  • Removed: Class III devices and KF modifier requirements which were moved to the Policy Specific Documentation Requirements section

03/11/2021: 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.

Speech Generating Devices (SGD)

PA

Speech Generating Devices (SGD) PAExternal Website

Revision Effective Date: 01/01/2020

CODING GUIDELINES:

  • Added: “(PCL)” after reference to “Product Classification List”
  • Revised: Coding verification review information, to include incorrect coding denial language for products billed using HCPCS that require written coding verification review

03/11/2021: 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.

Spinal Orthoses: TLSO and LSO

PA

Spinal Orthoses: TLSO and LSO PAExternal Website

Revision Effective Date: 02/01/2021

CODING GUIDELINES:

  • Removed: Reference to L0640 from list of prefabricated orthoses
  • Removed: HCPCS codes L0622 and L0624 from list of custom fabricated orthoses for which all products must be listed on the PCL
  • Added: “(PCL)” after reference to “Product Classification List”
  • Revised: Coding verification review information, to include incorrect coding denial language for products billed using HCPCS that require written coding verification review

03/11/2021: 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

STANDARD WRITTEN ORDER (SWO):

  • Revised: Reference to the Medicare Program Integrity Manual from 'Internet only manual' to 'CMS Pub.'

DOCUMENTATION REQUIREMENTS:

  • Revised: “DME MAC supplier” to “DMEPOS supplier” in second paragraph

CORRECT CODING:

  • Revised: Reference to the Medicare Program Integrity Manual from 'Internet only manual' to 'CMS Pub.'
  • Added: “45 CFR” in front of 162.1002 reference in first paragraph
  • Revised: ‘Durable Medical Equipment Coding System’ reference to ‘DMECS’ to match the PDAC website

REPAIRS/REPLACEMENT:

  • Revised: References to the Medicare Benefit Policy Manual from 'Internet only manual' to 'CMS Pub.'

SIGNATURE REQUIREMENTS:

  • Revised: Reference to the Medicare Program Integrity Manual from 'Internet only manual' to 'CMS Pub.'

03/11/2021: 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.

Vacuum Erection Devices (VED)

PA

Vacuum Erection Devices (VED) PAExternal Website

Revision Effective Date: 01/01/2020

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

  • Added: Social Security Act citation for non-coverage 1834(a)(1)(I)

03/11/2021: 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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