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October 7, 2021

LCD and Policy Article Revisions Summary for October 7, 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 High Frequency Chest Wall Oscillation Devices, Mechanical In-exsufflation Devices, Oral Anticancer Drugs, Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics), Transcutaneous Electrical Nerve Stimulators (TENS) and Wheelchair Seating. Please review the entire LCDs and related PAs for complete information.

High Frequency Chest Wall Oscillation Devices

PA

High Frequency Chest Wall Oscillation Devices PAExternal website

Revision Effective Date: 10/01/2021

ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY:

  • Revised: ICD-10-CM code G71.20 and M35.03 descriptions in Group 1 Codes, due to annual ICD-10-CM code updates

10/07/2021: At this time the 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: 10/01/2021

ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY:

  • Revised: ICD-10-CM code description for G71.20 due to annual ICD-10-CM Code updates

10/07/2021: 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 Anticancer Drugs

PA

Oral Anticancer Drugs PAExternal website

Revision Effective Date: 10/01/2021

ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY:

  • Added: ICD-10-CM C56.3 to groups 1, 2, 3, 4, 6, 7, 9, ICD-10-CM C79.63 to groups 2, 3, 4, 6, 7, 8, 9, ICD-10-CM C84.7A to groups 1, 3, 4, 5, 7 due to annual ICD-10-CM code updates

10/07/2021: At this time the 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: 10/01/2021

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

  • Removed: "multiple codes" after "netupitant/palonosetron" and replaced with J8655

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

  • Removed: References of "Q0181" and "depending on date of service" after palonosetron and netupitant/palonosetron
  • Added: Instructions for billing Q0181

CODING GUIDELINES:

Added: Directions for billing rolapitant based on multiple codes for the appropriate date of service

ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY:

  • Added: ICD-10-CM C56.3, C79.63 and C84.7A to Group 1 due to annual ICD-10-CM code updates

10/07/2021: At this time the 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.

Transcutaneous Electrical Nerve Stimulators (TENS)

LCD

Transcutaneous Electrical Nerve Stimulators (TENS) LCDExternal website

Revision Effective Date: 11/20/2021

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

  • Removed: Criterion III Chronic Lower Back Pain (CLBP) due to coverage expired June 7, 2015 under NCD 160.27
  • Added: Not reasonable and necessary statement in accordance with NCD 160.27

CODING INFORMATION:

  • Removed: Modifier Q0 under HCPCS Modifiers section

APPENDICES:

  • Removed: CLBP clinical trial references

10/7/2021: In accordance with NCD 160.27, coverage of TENS for CLBP is no longer available under Coverage with Evidence Development. Per the NCD, TENS is not reasonable and necessary for the treatment of CLBP under section 1862(a)(1)(A) of the Act. As a result, the DME MACs are removing this requirement as a non-discretionary change to the LCD, per the Program Integrity Manual, Chapter 13, §13.2.4.

PA

Transcutaneous Electrical Nerve Stimulators (TENS) PAExternal website

Revision Effective Date: 11/20/2021

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

  • Revised: Language regarding supply allowances during the rental period for clarification

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

  • Removed: Medical records statement for Criterion III as coverage expired June 7, 2015 for CLBP under NCD 160.27

MODIFIERS:

  • Removed: Q0 modifier statements regarding Criterion III as coverage expired June 7, 2015 for CLBP under NCD 160.27

ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY:

  • Removed: ICD-10-CM codes used for CLBP as coverage expired June 7, 2015 for CLBP under NCD 160.27

ICD-10-CM CODES THAT DO NOT SUPPORT MEDICAL NECESSITY:

  • Removed: Statement under paragraph 1 regarding CLBP and all codes not specified

10/07/2021: 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.

Wheelchair Seating

PA

Wheelchair Seating PAExternal website

Revision Effective Date: 10/01/2021

ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY:

  • Revised: ICD-10-CM code G71.20 description in Group 2 and Group 4 Codes, due to annual ICD-10-CM code updates
  • Added: ICD-10-CM code G04.82 to Group 2 and Group 4 Codes, due to annual ICD-10-CM code updates

10/07/2021: At this time the 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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