March 18, 2021
LCD and Policy Article Revisions Summary for March 18, 2021
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 Knee Orthoses, Lower Limb Prostheses, Mechanical In-exsufflation Devices, Negative Pressure Wound Therapy Pumps, Pressure Reducing Support Surfaces - Group 1, Pressure Reducing Support Surfaces - Group 2, Pressure Reducing Support Surfaces - Group 3, Surgical Dressings and Therapeutic Shoes for Persons with Diabetes. Please review the entire LCDs and related PAs for complete information.
Knee Orthoses
PA
Revision Effective Date: 02/01/2021
CODING GUIDELINES:
- Added: “(CVR)” after reference to coding verification review
- Added: “(PCL)” after reference to “Product Classification List”
- Revised: Coding verification review information, to include incorrect coding denial language for products billed using HCPCS that require written coding verification review
03/18/2021: 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.
Lower Limb Prostheses
PA
Revision Effective Date: 08/01/2020
CODING GUIDELINES:
- Removed: Trademark symbols
- Removed: “etc.” from the not all-inclusive list of other components of a prosthesis
- Revised: Infinite Socket TT-S information, to include addition HCPCS code L5637
- Revised: Coding guidelines for HCPCS codes L5968 and L5986
CODING VERIFICATION REVIEW:
- Added: “(PCL)” after reference to “Product Classification List”
- Added: Incorrect coding denial language for products billed using HCPCS that require written coding verification review
03/18/2021: 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.
Mechanical In-exsufflation Devices
PA
Mechanical In-exsufflation Devices PA
Revision Effective Date: 10/01/2020
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
- Added: Reimbursement statement for replacement of A7020
ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:
- Added: A7020 to Group 1 Paragraph
03/18/2021: 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.
Negative Pressure Wound Therapy Pumps
LCD
Negative Pressure Wound Therapy Pumps LCD
Revision Effective Date: 05/01/2021
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
- Revised: Roman to Arabic numerals in staging scheme
- Revised: “an” to “a” before NPWT
APPENDICES:
- Revised: Updated National Pressure Ulcer Advisory Panel to National Pressure Injury Advisory Panel and 2019 guidelines (unchanged from 2016 guidelines)
03/18/2021: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due grammatical or non-substantive changes.
PA
Negative Pressure Wound Therapy Pumps PA
Revision Effective Date: 01/01/2020
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
- Revised: “an” to “a” before NPWT
MODIFIERS:
- Revised: "an” to “a” before NPWT
03/18/2021: 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.
Pressure Reducing Support Surfaces - Group 1
LCD
Pressure Reducing Support Surfaces - Group 1 LCD
Revision Effective Date: 05/01/2021
APPENDICES:
- Revised: National Pressure Ulcer Advisory Panel to National Pressure Injury Advisory Panel and 2019 guidelines (unchanged from 2016 guidelines)
03/18/2021: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due grammatical or non-substantive changes.
PA
Pressure Reducing Support Surfaces - Group 1 PA
Revision Effective Date: 05/01/2021
RELATED CLINICAL INFORMATION:
- Revised: Roman to Arabic numerals in staging scheme
03/18/2021: 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.
Pressure Reducing Support Surfaces - Group 2
LCD
Pressure Reducing Support Surfaces - Group 2 LCD
Revision Effective Date: 05/01/2021
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
- Revised: Spelling error from ‘appropriatge’ to ‘appropriate’
- Revised: Roman to Arabic numerals in staging scheme
APPENDICES:
- Revised: National Pressure Ulcer Advisory Panel to National Pressure Injury Advisory Panel and 2019 guidelines (unchanged from 2016 guidelines)
03/18/2021: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due grammatical or non-substantive changes.
PA
Pressure Reducing Support Surfaces - Group 2 PA
Revision Effective Date: 01/01/2020
CODING GUIDELINES:
- Added: “(CVR)” after reference to coding verification review
- Added: “(PCL)” after reference to “Product Classification List”
- Revised: Coding verification review information, to include incorrect coding denial language for products billed using HCPCS that require written coding verification review
03/18/2021: 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.
Pressure Reducing Support Surfaces - Group 3
LCD
Pressure Reducing Support Surfaces - Group 3 LCD
Revision Effective Date: 05/01/2021
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
- Revised: Roman to Arabic numerals in staging scheme
APPENDICES:
- Revised: National Pressure Ulcer Advisory Panel to National Pressure Injury Advisory Panel 2019 guidelines (unchanged from 2016 guidelines)
03/18/2021: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due grammatical or non-substantive changes.
PA
Pressure Reducing Support Surfaces - Group 3 PA
Revision Effective Date: 01/01/2020
CODING GUIDELINES:
- Added: E0194 includes heavy duty and bariatric devices
03/18/2021: 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.
Surgical Dressings
LCD
Revision Effective Date: 05/01/2021
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
- Revised: Roman to Arabic numerals in staging scheme
DOCUMENTATION REQUIREMENTS:
- Revised: Statement to add in “treating practitioner’s”
APPENDICES:
- Revised: National Pressure Ulcer Advisory Panel to National Pressure Injury Advisory Panel and 2019 guidelines (unchanged from 2016 guidelines)
03/18/2021: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due grammatical or non-substantive changes.
PA
Revision Effective Date: 05/01/2021
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
- Revised: Roman to Arabic numerals in staging scheme
CODING GUIDELINES:
- Revised: Roman to Arabic numerals in staging scheme
- Added: “(CVR)” after reference to coding verification review
- Added: “(PCL)” after reference to “Product Classification List”
- Revised: Coding verification review information, to include incorrect coding denial language for products billed using HCPCS that require written coding verification review
03/18/2021: 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:
- Added: “(PCL)” after reference to “Product Classification List”
- Added: Incorrect coding denial language for products billed using HCPCS that require written coding verification review
03/18/2021: 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.