April 17, 2025
LCD and Policy Article Revisions Summary for April 17, 2025
Joint DME MAC Publication
Outlined below are the principal changes to the DME MAC Local Coverage Determination (LCD) and Policy Article (PA) that have been revised and posted. The policies included are Immunosuppressive Drugs and Standard Documentation Requirements for All Claims Submitted to DME MACs. Please review the entire LCD and PA for complete information.
Immunosuppressive Drugs
LCD
Revision Effective Date: 04/01/2025
HCPCS CODES:
- Added: HCPCS code J7521
04/17/2025: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates per CMS HCPCS coding determinations.
Standard Documentation Requirements for All Claims Submitted to DME MACs
PA
Standard Documentation Requirements for All Claims Submitted to DME MACs PA
Revision Effective Date: 01/01/2024
MEDICAL RECORD DOCUMENTATION:
- Added: Reference to the Social Security Act section 1834(h)(5) regarding documentation created by orthotists and prosthetists shall be considered part of the individual’s medical record to support documentation created by the treating practitioner as clarification
04/17/2025: 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.