March 25, 2021
Policy Article Revisions Summary for March 25, 2021
Outlined below are the principal changes to the DME MAC Policy Articles (PAs) that have been revised and posted. The policies included are Canes and Crutches, Eye Prostheses, Facial Prostheses, Manual Wheelchair Bases, Nebulizers, Power Mobility Devices, Wheelchair Options/Accessories, and Wheelchair Seating. Please review the entire Local Coverage Determinations (LCDs) and related PAs for complete information.
Canes and Crutches
PA
Revision Effective Date: 01/01/2020
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
- Revised: Non-coverage language for white canes and added NCD reference
03/25/2021: At this time the 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.
Eye Prostheses
PA
Revision Effective Date: 01/01/2020
CODING GUIDELINES:
- Removed: Trademark symbols from PROSE references, per AMA guidelines
03/25/2021: At this time the 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.
Facial Prostheses
PA
Revision Effective Date: 01/01/2020
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
- Added: Modifiers section and related information for modifiers AV, KM, KN, RT and LT
CODING GUIDELINES:
- Removed: KM and RT/LT modifier instructions. Relocated to Modifiers section within Policy Specific Documentation Requirements
03/25/2021: At this time the 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.
Manual Wheelchair Bases
PA
Revision Effective Date: 01/01/2020
CODING GUIDELINES:
- Added: Coding verification review information for HCPCS code K0009 (effective for dates of service on or after 06.01.2013)
- Added: Incorrect coding denial language for products billed using HCPCS that require written coding verification review
- Removed: Reference to HCPCS codes for billing of maintenance and service
03/25/2021: At this time the 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.
Nebulizers
PA
Revision Effective Date: 05/17/2020
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
- Removed: Trademark symbol from Foradil Aerolize, per AMA guidelines
- Revised: Day references to include hyphen
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
- Added: HCPCS codes J7605, J7606, and J7686 to statement regarding KP KQ modifiers
03/25/2021: At this time the 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.
Power Mobility Devices
PA
Revision Effective Date: 01/01/2020
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
- Revised: "physician's" to "practitioner's"
MISCELLANEOUS:
- Revised: "coding verification determination" to "coding verification review"
- Added: "CVR" after reference to "coding verification review"
- Added: "PCL" after reference to "Product Classification List"
- Revised: Coding verification review reference of "devices" to "products"
- Added: Incorrect coding denial language for products billed using HCPCS that require written coding verification review
03/25/2021: At this time the 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.
Wheelchair Options/Accessories
PA
Wheelchair Options/Accessories PA
Revision Effective Date: 01/01/2020
CODING GUIDELINES:
- Removed: Reference to HCPCS codes for replacement-only items
03/25/2021: At this time the 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.
Wheelchair Seating
PA
Revision Effective Date: 10/01/2020
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
- Added: References to refer to group codes in the ICD-10 code list section
CODING GUIDELINES:
- Revised: References of positioning back cushion HCPCS codes, from "E2314" and "E2315" to "E2614" and "E2615" respectively
- Added: HCPCS code E2610 to list of HCPCS codes for which products require written coding verification review
- Added: "CVR" after reference to "coding verification review"
- Added: "(PCL)" after reference to "Product Classification List"
- Revised: Coding verification review language for products that must be billed with HCPCS code K0669
- Added: Incorrect coding denial language for products billed using HCPCS that require written coding verification review
03/25/2021: At this time the 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.