March 20, 2025
Policy Article Revision Summary for March 20, 2025
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 Ostomy Supplies and Urological Supplies. Please review the entire Local Coverage Determinations (LCDs) and related PAs for complete information.
Ostomy Supplies
PA
Revision Effective Date: 01/01/2022
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
- Added: “Ostomy supplies are covered for a beneficiary who has a permanent impairment requiring an ostomy. A permanent ostomy is defined as a condition that is not expected to be medically or surgically corrected in that beneficiary. Permanence is a condition that is of a long and indefinite duration. This does not require a determination that there is no possibility that the beneficiary's condition may improve sometime in the future. If the medical record, including the judgment of the treating practitioner, indicates the condition is of long and indefinite duration, the test of permanence is considered met. Ostomy supplies will be denied as non-covered in situations in which it is expected that the condition will be temporary.” as clarification
03/20/2025: 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.
Urological Supplies
PA
Revised Effective Date: 04/01/2023
GENERAL:
- Removed: “Permanent urinary retention is defined as retention that is not expected to be medically or surgically corrected in that beneficiary within 3 months” and “(ordinarily at least 3 months)” as clarification
03/20/2025: 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/or PAs. For complete information on any topic, you must review the LCDs and/or PAs.