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September 17, 2020

LCD and Policy Article Revisions Summary for September 17, 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: 09/15/2020

COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:

  • Removed: Information related to HCPCS code E0787, which is invalid for Medicare submission for DOS on or after 9/15/2020
  • Added: Information regarding external ambulatory insulin infusion pumps that incorporate dose rate adjustment using therapeutic continuous glucose sensing

CODING INFORMATION:

  • Removed: HCPCS code E0787 from Group 1 HCPCS Codes
  • Removed: HCPCS code A4226 from Group 2 HCPCS Codes

09/17/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are due to Non-Discretionary HCPCS code changes rendering them invalid for submission to Medicare.

PA

External Infusion Pumps PAExternal Website

Revision Effective Date: 09/15/2020

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:

  • Removed: Information related to HCPCS code E0787, which is invalid for Medicare submission for DOS on or after 09/15/2020

MODIFIERS:

  • Removed: HCPCS code E0787

CODING GUIDELINES:

  • Removed: Guidelines for HCPCS codes E0787 and A4226
  • Added: Coding guidelines for insulin infusion pumps with integrated continuous glucose sensing capabilities

ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:

  • Removed: HCPCS code E0787 from Group 1 Paragraph

09/17/2020: 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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