March 1, 2012
LCD and Policy Article Revisions Summary for March 1, 2012
Outlined below are the principal changes to DME MAC Local Coverage Determinations (LCDs) and Policy Articles (PAs) that have been revised and posted. Please review the entire LCD and each related PA for complete information.
Ankle-Foot/Knee-Ankle-Foot Orthosis
LCD
Revision Effective Date: 01/01/2012
INDICATIONS AND LIMITATIONS OF COVERAGE:
- Revised: Order requirements language to specify a “detailed written order”
- Changed: Word “Patient” to “Beneficiary”
DOCUMENTATION REQUIREMENTS:
(Note: The effective date above is not applicable to this section. These revised and added requirements are existing Medicare requirements which are now included in the LCD for easy reference)
- Revised: Prescription requirements
- Added: Medical Record Information
Immunosuppressive Drugs
LCD
Revision Effective Date: 01/01/2012
INDICATIONS AND LIMITATIONS OF COVERAGE AND MEDICAL NECESSITY:
- Revised: Order requirement language to specify a “detailed written order”
- Added: Refill requirements per PIM 5.2.6 (effective 08/02/2011 per CR7452)
HCPCS CODES:
- Added: J8561
DOCUMENTATION REQUIREMENTS:
(Note: The effective date above is not applicable to this section. These revised and added requirements are existing Medicare requirements which are now included in the LCD for easy reference)
- Revised: Prescription requirements
- Added: Refill Requirements, general medical record information requirements and proof of delivery requirements
Intravenous Immune Globulin
LCD
Revision History Effective Date: 01/01/2012
INDICATIONS AND LIMITATIONS OF COVERAGE AND MEDICAL NECESSITY:
- Revised: Order requirement language to specify a “detailed written order”
- Added: Refill requirements per PIM 5.2.6 (effective 08/02/2011 per CR7452)
HCPCS CODES:
- Added: J1557
DOCUMENTATION REQUIREMENTS:
(Note: The effective date above is not applicable to this section. These revised and added requirements are existing Medicare requirements which are now included in the LCD for easy reference)
- Revised: Prescription requirements
- Added: Refill requirements, general medical record information requirements, continued use and continued need requirements, and proof of delivery requirements
Lower Limb Prostheses
LCD
Revision Effective Date: 01/01/2012
INDICATIONS AND LIMITATIONS OF COVERAGE
- Revised: Order requirement language to specify a “detailed written order”
- Changed: Word “Patient” to Beneficiary”
HCPCS CODES AND MODIFIERS
- Added: L5312
DOCUMENTATION REQUIREMENTS:
(Note: The effective date above is not applicable to this section. These revised and added requirements are existing Medicare requirements which are now included in the LCD for easy reference)
- Revised: Prescription requirements
- Added: Medical Record Information
Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics)
LCD
INDICATIONS AND LIMITATIONS OF COVERAGE AND MEDICAL NECESSITY:
- Revised: Order requirement language to specify a “detailed written order”
- Added: Refill requirements per PIM 5.2.6 (effective 08/02/2011 per CR7452)
HCPCS CODES:
- Added: Q0162
DOCUMENTATION REQUIREMENTS:
(Note: The effective date above is not applicable to this section. These revised and added requirements are existing Medicare requirements which are now included in the LCD for easy reference)
- Revised: Prescription requirements
- Added: Refill requirements, general medical record information requirements and proof of delivery requirements
Ostomy Supplies
LCD
Revision History Effective Date: 01/01/2012
INDICATIONS AND LIMITATIONS OF COVERAGE AND MEDICAL NECESSITY:
Revised:
- Order requirement language to specify a “detailed written order”
HCPCS CODES:
- Added: A5056 and A5057
DOCUMENTATION REQUIREMENTS:
(Note: The effective date above is not applicable to this section. These revised and added requirements are existing Medicare requirements which are now included in the LCD for easy reference)
- Added: General medical record information requirements and proof of delivery requirements
Suction Pumps
LCD
Revision Effective Date: 04/15/2012
INDICATIONS AND LIMITATIONS OF COVERAGE:
- Added: Preamble
- Added: A9272 (effective 01/01/2012)
- Added: Refill requirements per PIM 5.2.6 (effective 08/02/2011 per CR7452)
- Added: Gastric pump (E2000) coverage statement
- Removed: Extra supplies statement
- Added: Coverage statement about K0743 and related supplies
- Revised: “Reasonable and necessary “for “medically necessary”
HCPCS CODES AND MODIFIERS
- Added: A9272
- Added: K0743 – K0746 (Effective 07/01/2011)
DOCUMENTATION REQUIREMENTS :
( Note: The effective date above is not applicable to this section. These revised and added requirements are existing Medicare requirements which are now included in the LCD for easy reference)
- Revised: Prescription requirements
- Added: Refill requirements, general medical record information requirements, continued use and continued need requirements, and proof of delivery requirements
PA
Revision Effective Date: 01/01/2012
NONMEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
- Added: Preamble
- Added: Benefit Category Statement
- Added: A9272 to noncovered statement about disposable devices.
CODING GUIDELINES:
- Added: K0743 – K0746
- Added: PDAC review requirement for K0743
- Added: A9272
- Revised: A9270 to exclude A9272 devices
Wheelchair Options/Accessories
LCD
INDICATIONS AND LIMITATIONS OF COVERAGE:
- Revised: Order requirement
- Added: E0988, E2358, E2359
HCPCS CODES AND MODIFIERS:
- Added: E0988, E2358, E2359
- Replaced: “Patient” with “beneficiary”
DOCUMENTATION REQUIREMENTS: (Note: The effective date above is not applicable to this section. These revised and added requirements are existing Medicare requirements which are now included in the LCD for easy reference)
- Revised: Prescription requirements
- Added: General medical record information requirements, continued use and continued need requirements, and proof of delivery requirements
PA
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
- Added: E2359
CODING GUIDELINES:
- Added: E0988
- Clarified: billing instructions for Power Wheelchairs for armrests versus separate billing for detachable adjustable height armrests: corrected K0020 and added as adjustable. Removed K0020 from bundling table.
Note: The information contained in this article is only a summary of revisions to LCDs and Policy Articles. For complete information on any topic, you must review the LCD and/or Policy Article at http://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx.
A webinar to enhance your understanding will be coming soon.
