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July 23, 2020

LCD and Policy Article Revisions Summary for July 23, 2020

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 policy included is External Infusion Pumps. Please review the entire LCD and related PA for complete information.

External Infusion Pumps

LCD

External Infusion Pumps LCDExternal Website

Revision Effective Date: 09/06/2020

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

  • Revised: J7799 (Xembify) to J1558 for Dates of Service on or after 07/01/2020
  • Clarification: Coverage for Xembify effective for Dates of Service on or after 07/3/2019 (FDA Approval Date)
  • Added: Cutaquig to coverage criteria V(H) effective for Dates of Service on or after 12/12/2018 (FDA Approval Date)
  • Added: Statement regarding covered pumps for Cutaquig

SUMMARY OF EVIDENCE:

  • Added: Information related to Cutaquig

ANALYSIS OF EVIDENCE:

  • Added: Information related to Cutaquig

CODING INFORMATION:

  • Added: HCPCS code J1558 to Group 3 table

BIBLIOGRAPHY:

  • Added: Section related to Cutaquig

RELATED LOCAL COVERAGE DOCUMENTS:

  • Added: Response to Comments document A58288

PA

External Infusion Pumps PAExternal Website

Revision Effective Date: 09/06/2020

MODIFIERS:

  • Added: J1558 and J7799 (Cutaquig) to the JB modifier requirements

CODING GUIDELINES:

  • Added: Billing instructions for Xembify based on DOS
  • Added: UOS billing instruction for J7799 (Cutaquig)

ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:

  • Added: J1558 and J7799 (Cutaquig) to the Group 3 paragraph

07/23/2020: 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 PAs. For complete information on any topic, you must review the LCDs and/or PAs.

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