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December 5, 2024

Policy Article Revisions Summary for December 5, 2024

Joint DME MAC Publication

Outlined below are the principal changes to the DME MAC Policy Articles (PAs) that have been revised and posted. The policies included are Nebulizers, Surgical Dressings, and Therapeutic Shoes for Persons with Diabetes. Please review the entire Local Coverage Determinations (LCDs) and related PAs for complete information.

Nebulizers

PA

Nebulizers PAExternal Website

Revision Effective Date: 01/01/2024

CODING GUIDELINES:

  • Revised: “0.83%” to “0.083%” in the example regarding the provision of albuterol solution and billed units of service for HCPCS code J7613

12/05/2024: 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.

Surgical Dressings

PA

Surgical Dressings PAExternal Website

Revision Effective Date: 12/05/2024

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS

  • Removed: “The size of the dressing (if applicable); and,” from the documentation list the treating practitioner’s medical record, nursing home, or home care nursing records must specify for initial wound evaluations
  • Added: “Claim lines for A6501, A6502, A6503, A6504, A6505, A6506, A6507, A6508, A6509, A6510, A6511, A6512, and A6513 do not require the A1-A9 modifier or the AW modifier.”

12/05/2024: 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.

Therapeutic Shoes for Persons with Diabetes

PA

Therapeutic Shoes for Persons with Diabetes PAExternal Website

Revision Effective Date: 12/05/2024

CODING GUIDELINES:

  • Revised: “If an insert is not included in one of these categories of items (A5512, A5513, A5514), it must be billed with code A5510 or A9270 (noncovered item).” to “If an insert for a diabetic shoe does not meet the coding guidelines of A5512, A5513, or A5514, then the insert must be billed using either HCPCS code A5510 or A9270 (noncovered item).” as clarification
  • Removed: Coding verification review information for HCPCS codes A5512, A5513, and A5514

CODING VERIFICATION REVIEW:

  • Added: Section header and PDAC coding verification review information
  • Added: Coding verification review information for HCPCS codes A5512 and A5513
  • Added: Coding verification review information for HCPCS code A5514, for claims with dates of service on or after January 1, 2019 through December 4, 2024
  • Added: Coding verification review information for HCPCS code A5514, for claims with dates of service on or after December 5, 2024

12/05/2024: 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/or PAs. For complete information on any topic, you must review the LCDs and/or PAs.

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