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March 18, 2021

LCD and Policy Article Revisions Summary for March 18, 2021

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 Knee Orthoses, Lower Limb Prostheses, Mechanical In-exsufflation Devices, Negative Pressure Wound Therapy Pumps, Pressure Reducing Support Surfaces - Group 1, Pressure Reducing Support Surfaces - Group 2, Pressure Reducing Support Surfaces - Group 3, Surgical Dressings and Therapeutic Shoes for Persons with Diabetes. Please review the entire LCDs and related PAs for complete information.

Knee Orthoses

PA

Knee Orthoses PAExternal Website

Revision Effective Date: 02/01/2021

CODING GUIDELINES:

  • Added: “(CVR)” after reference to coding verification review
  • 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

03/18/2021: 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.

Lower Limb Prostheses

PA

Lower Limb Prostheses PAExternal Website

Revision Effective Date: 08/01/2020

CODING GUIDELINES:

  • Removed: Trademark symbols
  • Removed: “etc.” from the not all-inclusive list of other components of a prosthesis
  • Revised: Infinite Socket TT-S information, to include addition HCPCS code L5637
  • Revised: Coding guidelines for HCPCS codes L5968 and L5986

CODING VERIFICATION REVIEW:

  • Added: “(PCL)” after reference to “Product Classification List”
  • Added: Incorrect coding denial language for products billed using HCPCS that require written coding verification review

03/18/2021: 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.

Mechanical In-exsufflation Devices

PA

Mechanical In-exsufflation Devices PAExternal Website

Revision Effective Date: 10/01/2020

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

  • Added: Reimbursement statement for replacement of A7020

ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:

  • Added: A7020 to Group 1 Paragraph

03/18/2021: 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.

Negative Pressure Wound Therapy Pumps

LCD

Negative Pressure Wound Therapy Pumps LCDExternal Website

Revision Effective Date: 05/01/2021

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

  • Revised: Roman to Arabic numerals in staging scheme
  • Revised: “an” to “a” before NPWT

APPENDICES:

  • Revised: Updated National Pressure Ulcer Advisory Panel to National Pressure Injury Advisory Panel and 2019 guidelines (unchanged from 2016 guidelines)

03/18/2021: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due grammatical or non-substantive changes.

PA

Negative Pressure Wound Therapy Pumps PAExternal Website

Revision Effective Date: 01/01/2020

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

  • Revised: “an” to “a” before NPWT

MODIFIERS:

  • Revised: "an” to “a” before NPWT

03/18/2021: 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.

Pressure Reducing Support Surfaces - Group 1

LCD

Pressure Reducing Support Surfaces - Group 1 LCDExternal Website

Revision Effective Date: 05/01/2021

APPENDICES:

  • Revised: National Pressure Ulcer Advisory Panel to National Pressure Injury Advisory Panel and 2019 guidelines (unchanged from 2016 guidelines)

03/18/2021: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due grammatical or non-substantive changes.

PA

Pressure Reducing Support Surfaces - Group 1 PAExternal Website

Revision Effective Date: 05/01/2021

RELATED CLINICAL INFORMATION:

  • Revised: Roman to Arabic numerals in staging scheme

03/18/2021: 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.

Pressure Reducing Support Surfaces - Group 2

LCD

Pressure Reducing Support Surfaces - Group 2 LCDExternal Website

Revision Effective Date: 05/01/2021

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

  • Revised: Spelling error from ‘appropriatge’ to ‘appropriate’
  • Revised: Roman to Arabic numerals in staging scheme

APPENDICES:

  • Revised: National Pressure Ulcer Advisory Panel to National Pressure Injury Advisory Panel and 2019 guidelines (unchanged from 2016 guidelines)

03/18/2021: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due grammatical or non-substantive changes.

PA

Pressure Reducing Support Surfaces - Group 2 PAExternal Website

Revision Effective Date: 01/01/2020

CODING GUIDELINES:

  • Added: “(CVR)” after reference to coding verification review
  • 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

03/18/2021: 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.

Pressure Reducing Support Surfaces - Group 3

LCD

Pressure Reducing Support Surfaces - Group 3 LCDExternal Website

Revision Effective Date: 05/01/2021

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

  • Revised: Roman to Arabic numerals in staging scheme

APPENDICES:

  • Revised: National Pressure Ulcer Advisory Panel to National Pressure Injury Advisory Panel 2019 guidelines (unchanged from 2016 guidelines)

03/18/2021: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due grammatical or non-substantive changes.

PA

Pressure Reducing Support Surfaces - Group 3 PAExternal Website

Revision Effective Date: 01/01/2020

CODING GUIDELINES:

  • Added: E0194 includes heavy duty and bariatric devices

03/18/2021: 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.

Surgical Dressings

LCD

Surgical Dressings LCDExternal Website

Revision Effective Date: 05/01/2021

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

  • Revised: Roman to Arabic numerals in staging scheme

DOCUMENTATION REQUIREMENTS:

  • Revised: Statement to add in “treating practitioner’s”

APPENDICES:

  • Revised: National Pressure Ulcer Advisory Panel to National Pressure Injury Advisory Panel and 2019 guidelines (unchanged from 2016 guidelines)

03/18/2021: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due grammatical or non-substantive changes.

PA

Surgical Dressings PAExternal Website

Revision Effective Date: 05/01/2021

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

  • Revised: Roman to Arabic numerals in staging scheme

CODING GUIDELINES:

  • Revised: Roman to Arabic numerals in staging scheme
  • Added: “(CVR)” after reference to coding verification review
  • 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

03/18/2021: 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.

Therapeutic Shoes for Persons with Diabetes

PA

Therapeutic Shoes for Persons with Diabetes PAExternal Website

Revision Effective Date: 11/05/2020

CODING GUIDELINES:

  • Added: “(PCL)” after reference to “Product Classification List”
  • Added: Incorrect coding denial language for products billed using HCPCS that require written coding verification review

03/18/2021: 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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