Skip to Main Content

Print | Bookmark | Font Size: + |

October 30, 2025

LCD and Policy Article Revisions Summary for October 30, 2025

Joint DME MAC Publication

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 Power Mobility Devices, Respiratory Assist Devices, Speech Generating Devices (SGD), Walkers, and Wheelchair Options/Accessories. Please review the entire LCDs and PAs for complete information.

Power Mobility Devices

LCD

Power Mobility Devices LCDExternal Website

Revision Effective Date: 10/01/2025

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

  • Revised: Language pertaining to HCPCS code E0986, by revising "push-rim activated power assist device (E0986)" to "power assist system (E0986)"

HCPCS CODES:

  • Revised: Long description of HCPCS code E0986

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

  • Revised: "push-rim activated power assist device" to "power assist system" in language that pertains to a specialty evaluation
  • Revised: "push-rim activated power assist" to "power assist system" in language that pertains to a specialty evaluation

10/30/2025: 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 and non-substantive to align with the HCPCS long description.

PA

Power Mobility Devices PAExternal Website

Revision Effective Date: 10/01/2025

POLICY SPECIFIC DOCUMENTATION:

  • Revised: "push-rim activated power assist" to "power assist system" in language that pertains to a specialty evaluation

MODIFIERS:

  • Revised: "If the power mobility device or push-rim activated power assist device that is provided is only needed for mobility outside the home, the GY modifier must be added to the codes for the item and all accessories." to "If the power mobility device or power assist system that is provided is only needed for mobility outside the home, the GY modifier must be added to the codes for the item and all accessories."

CODING GUIDELINES:

  • Revised: Information pertaining to Non-expandable Controller definition, by revising "power seating actuators through the drive control" to "power actuators" and by revising "power seating actuators though" to "power actuators through"
  • Revised: Information pertaining to Expandable Controller definition, by revising "powered seating actuators through the drive control" to "powered actuators," by adding examples of powered actuators, by revising "power seating actuators though" to "power actuators through," and by removing "E2310 or" from the reference of an additional component required when control of the power actuators is through the Control Input Device
  • Added: "Power seat elevation" to the motors referenced as those that E2310 and E2311 allow the patient to control from a single interface
  • Revised: "captains chair" to "captain's chair"
  • Revised: "Captains chair" to "Captain's chair"
  • Revised: "Push-rim activated power assist (E0986)" to "Power assist system (E0986)" and the information pertaining to the definition of the power assist system
  • Added: "Power add-on" and definition information
  • Revised: "captains chairs" to "captain's chairs"

10/30/2025: 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.

Respiratory Assist Devices

LCD

Respiratory Assist Devices LCDExternal Website

Revision Effective Date: 06/09/2025

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

  • Revised: "INITIAL COVERAGE CRITERIA FOR E0470 AND E0471 DEVICES FOR THE FIRST THREE MONTHS OF THERAPY" to "INITIAL COVERAGE CRITERIA FOR E0470 AND E0471 DEVICES"

10/30/2025: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates due to NCD 240.9 Noninvasive Positive Pressure Ventilation (NIPPV) in the Home for the Treatment of Chronic Respiratory Failure (CRF) Consequent to Chronic Obstructive Pulmonary Disease (COPD).

Speech Generating Devices (SGD)

LCD

Speech Generating Devices (SGD) LCDExternal Website

Revision Effective Date: 10/01/2024

HCPCS CODES:

  • Added: HCPCS code A4601 to Group 1 Codes

10/30/2025: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates.

Walkers

PA

Walkers PAExternal Website

Revision Effective Date: 10/01/2025

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

  • Added: "A combination wheeled walker with seat and transport chair (E0150) is noncovered as it does not meet the definition of DME."

10/30/2025: 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.

Wheelchair Options/Accessories

LCD

Wheelchair Options/Accessories LCDExternal Website

Revision Effective Date: 10/01/2025

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

  • Revised: "For information concerning a push-rim activated power assist device for a manual wheelchair, refer to the Power Mobility Devices medical policy." to "For information concerning a power assist system for a manual wheelchair, refer to the Power Mobility Devices medical policy."

10/30/2025: Pursuant to the 21st Century Cures Act, this revision does not require notice and comment because the revision is non-substantive to align with information in the Power Mobility Devices medical policy.

PA

Wheelchair Options/Accessories PAExternal Website

Revision Effective Date: 10/01/2025

CODING GUIDELINES:

  • Revised: "For information concerning a push-rim activated power assist device for a manual wheelchair, refer to the Power Mobility Devices medical policy." to "For information concerning a power assist system for a manual wheelchair, refer to the Power Mobility Devices medical policy."
  • Revised: Information pertaining to non-expandable controller, by revising "power seating actuators through the drive control" to "power actuators" and by revising "power seating actuators though" to "power actuators through"
  • Revised: Information pertaining to expandable controller, by revising "powered seating actuators through the drive control" to "powered actuators," by adding examples of powered actuators, by revising "power seating actuators though" to "power actuators through," and by removing "E2310 or" from the reference of an additional component required when control of the power actuators is through the Control Input Device

10/30/2025: 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