Skip to Main Content

Print | Bookmark | Font Size: + |

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

Immunosuppressive Drugs LCDExternal Website

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 PAExternal Website

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.

spacer

26 Century Blvd Ste ST610, Nashville, TN 37214-3685 © CGS Administrators, LLC. All Rights Reserved