July 7, 2022
Policy Article Revisions Summary for July 7, 2022
Outlined below are the principal changes to the DME MAC Policy Articles (PAs) that have been revised and posted. The policies included are Spinal Orthoses: TLSO and LSO and Therapeutic Shoes for Persons with Diabetes. Please review the entire Local Coverage Determinations (LCDs) and related PAs for complete information.
Spinal Orthoses: TLSO and LSO
PA
Spinal Orthoses: TLSO and LSO PA
Revision Effective Date: 07/07/2022
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
- Revised: "coding guideline" and "Coding Guidelines" to "CODING GUIDELINES" in reference to section
- Removed: Statement that pertained to the effective date for coding verification review requirement and to statutory denial
- Revised: "CAD-CAM" to "computer-aided design/computer-aided manufacturing (CAD/CAM)"
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
- Revised: "off-the-shelf" to "OTS"
- Revised: "Coding Guidelines" to "CODING GUIDELINES" in reference to section
- Removed: Information pertaining to that which suppliers must do when providing these items
CODING GUIDELINES:
- Revised: "three point" to "three-point"
- Revised: "L codes" to "L-codes"
- Removed: Statement that referred to Documentation Requirements section of the LCD for instructions concerning use of the CG modifier
- Removed: Statement that pertained to billing when CAD/CAM technology used to fabricate an orthosis
CODING VERIFICATION REVIEW:
- Added: Section header and PDAC coding verification review information
- Revised: Reference to the coding verification review effective date for HCPCS codes L0455, L0457, L0467, L0469, L0641, L0642, L0643, L0648, L0649, L0650, L0651
07/07/2022: 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.
Therapeutic Shoes for Persons with Diabetes
PA
Therapeutic Shoes for Persons with Diabetes PA
Revision Effective Date: 11/05/2020
CODING GUIDELINES:
- Removed: Reference of HCPCS codes for inserts and modifications used with L-coded footwear
- Added: Language referring to the Orthopedic Footwear LCD and LCD-related Policy Article for more information
- Added: Language referring to the Lower Limb Prostheses LCD and LCD-related Policy Article for information pertaining to coverage of devices under the prosthetic devices benefit category
07/07/2022: 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.